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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: $25.00+$5.00/lot <br /> Owner: 16 6 '�D S F_ <br /> Address: <br /> W/IZ 809 8 Sc� It yt�i,7 C(1a�-� <br /> Lb5'fa} Phone: 6)5V- �29`711 <br /> Original Parcel Information <br /> � 1 I, p t1 , / 3 <br /> Parcel Identification#: �`�_`/�6-"����tion '"// Township 7�N Range z <br /> Original Description (or attach copy): rAIW/l Sv y <br /> PllbE o! fGl A P'l7 n. <br /> 0 <br /> Current Zoning: 3 Floodplain Y/N: Wetland&: - ; <br /> 0 <br /> A <br /> '— Lake/River Classification: Name of Water Body: <br /> m <br /> 0 <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: C: /rJ Z �07J <br /> d srn V 1 a P I qJ-43 <br /> L—&t7 / 0315-7 Le—V_ c;�— 60 10/11`ecres: 3 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: LO/lIG La-�5� QQ l� <br /> Proposed access to public waters to be provided Y/N: O <br /> If yes, describe access: <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> ➢ Does parcel require a Survey? Yes No c <br /> ➢ Permit application fees submitted? �] Amount$ 35r 00 Receipt# <br /> x <br /> r Reconciles With Real Property Lister Yes No Date: <br /> 0 <br /> rzlo <br /> a <br /> aIf not,explain: <br /> a o'^ <br /> H _r) <br /> 1 <br /> C> <br /> Application: pproved / Denied Reason for Denial: W <br /> 0 <br /> Land Use: � �GC G?l l� Date: <br /> 2/18/2003 /I U <br /> S t&m.p-- <br />