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14'A� <br /> Burnett Couno�bQ � it `plication Fees(must accompany form): <br /> Subdivision w/o Survey: $10.00 <br /> and/or Pre-Application Form Subdivision w/Survey:$100.00+$15.00/lot <br /> Owner: &�"4 / <br /> Address: 6 �i -1 /6— <br /> Phone: <br /> 1 /6— <br /> Phone: 3�9- 21750 <br /> A <br /> Oriexxi/nal Parcel Information 'g <br /> Parcel Identification#: (J�� 220 - t"JI7II D Section Township 9Range <br /> /} o <br /> Original Description (or attach copy): (�d V LOT <br /> ad <br /> Current Zoning: Q wz Floodplain Y6. Wetlands Y6 <br /> V <br /> V Lake/River Classification: — Name of Water Body: <br /> n <br /> m <br /> 7 <br /> w <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: 0,/n <br /> Acres: 503 <br /> (If parcel is to be surveyed,provide preliminary map. <br /> See <br /> attached for preliminary map req �ljrements.) <br /> Proposed access to public road: <br /> v <br /> Proposed access to public waters to be provided <br /> If yes,describe access: <br /> ➢ Does parcel meet Zoning Requiremen . Yes No <br /> N A <br /> ➢ Does parcel require a Survey? Yes No 2 <br /> 7 D <br /> JQ C <br /> ➢ Permit application fees submitted? ❑ Amount$ Receipt# <br /> a <br /> v <br /> ❑ Reconciles With Real Property Lister Yes No Date: <br /> CL <br /> If not,explain: <br /> o � <br /> a � <br /> Applicati Approved / D hied Reason for Denial: <br /> Land Use Date 1-2_/y s <br /> 2/18/2003 <br />