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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> Subdivision w/o Survey: $10.00 <br /> and/or Pre-Application Form Subdivision w/Survey:$100.00+$15.00/lot <br /> Owner: DAAL.MElEZ -D£v£LoT-w\LNT. l (A.KA.$CZoc_v_'DAUl N1 E l ER) <br /> Address: W)ZS SrANbl4a T,est:> <br /> f�wo* M1 4 _ 5430) Phone: 95Z .�112 .43z5 <br /> A <br /> Orieinal Parcel Information 'g <br /> C)zs-N17JO-03 coo Z$ Awl:. <br /> Parcel Identification#:oz S- z4 Zo1 '10o Section 2(o Township 410 Range 14 e <br /> OZS- 4j)Z5-o1 800 CIS <br /> Original Description(or attach copy): C, <br /> ?WZ'T of GOvEQWPlEIJ1- Lor I , Stc-Ttat3 2.(o .Nn <br /> VA2T OF Fi�£Q.NM�i.�r LAT3 SLGTtOtJ ;25 0 <br /> y Current Zoning: -Pte-(— Floodplain Y/N: Yes Wetlands Y/N: Yee) <br /> d'+ <br /> Lake/River Classification: Name of Water Body: 11(a tAck � La10E <br /> m EazT � <br /> P <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: :�ss i.1 rr,A(.uGiz�. C51� <br /> a <br /> Acres: 1t.50Z_ <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: SLtr A nAcA4r� C.SK <br /> 0 <br /> Proposed access to public waters to be provided YIN: yes A <br /> If yes,describe access: SLL AarxcAwb Lt:% <br /> 0 <br /> ➢ Does parcel meet Zoning Requirement Yes No <br /> v <br /> N c➢ Does parcel require a Survey? Yes No g <br /> w° o <br /> e <br /> ➢ Permit application fees submitted? ❑ Amount,$ I b0,Db Receipt# g06,( <br /> a <br /> ❑ Reconciles With Real Property Lister Yes No Date: <br /> w ° <br /> a � <br /> RIf not,explain: Ww <br /> a o0_ W <br /> opo <br /> Applicatio �Approvedenied Reason for Denial: o <br /> Land Use: Date: 6 f <br /> vls/2003 <br />