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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> Subdivision w/o Survey: $10.00 <br /> and/or :S <br /> r Pre-Application Form Subdivisionw/Survey100.00+$15.00hot <br /> Owner: 1�2 I I G Tb E <br /> Address: 9 Cz mo_-o QUA <br /> a _'LhVa 5223 Phone: <br /> ro <br /> m <br /> Original Parcel Information / 'g <br /> Parcel Identificatio M y J) 16- C 59(Aection// /U Township Range o <br /> Original Descriptio (or attach copy): L y;h So , b F C T H 'C <br /> G <br /> Current Zoning: kkl Floodplaic Wetland <br /> Lake/River Classification: — Name of Water Body: <br /> m � <br /> o <br /> New Parcel Information <br /> P g P �Gll :✓din ti tGL GX� �. <br /> Proposed New Legal Desc tion and Parcel Size: � <br /> Acres: 1, J Ll <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access topublic road: r H <br /> d <br /> Proposed access top iblic waters to be provided Y/V <br /> If yes,describe acces : 00 <br /> O <br /> D a <br /> ➢ Does parcel meet oning Requirements? Yes No Sotlus-Y � �tcis kG PaN1�04 Lj <br /> 5 ➢ Does parcel requiy e a S ey? Yes No <br /> O C <br /> ➢ Permit application fees submitted? ❑ Amount$ Receipt# <br /> r d <br /> ❑ Reconciles With Real Property Lister Yes No Date: <br /> a � <br /> If not,explain: <br /> 0 <br /> a ON <br /> O <br /> Application: Appro ed / enied Reason for Denial: <br /> 00 <br /> 'd <br /> Land Use 'T I r Date: 2J <br /> 2/18/2003 <br />