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Burnett County Subdivision Permit Application FFecs(must company form): <br /> /o Survey: SI10.00 <br /> and/or Pre-Applicatio Form v/Survey:$100.00+515.00/lot <br /> Owner: (�fic OL \ AZ T E <br /> Address: Z Z S L 3 L k ?0 (� TZ U A, D <br /> Z �j TS 3y 2(o lam.) one: (fl J <br /> Ori inal Parcel Information 3 <br /> Parcel Identification #: Section Z Township Range c <br /> Original Description (or attach copy): <br /> IO <br /> J < <br /> 9 Current Zoning: Floodpia n Y/N: Wetlands I /N: <br /> 7 <br /> Lake/River Classification: Name of Water Bo <br /> d <br /> NeireelInformationr <br /> Proposed New Legal Description and Parcel Size: C C e <br /> Acres <br /> (If parcel is to be surveyed,provide preliminary n ap. See attached for pr A minary map equirement .) <br /> Proposed access to public road: <br /> v <br /> Proposed access to public waters to be provided Y/N: A <br /> If yes,describe access: �7 <br /> i <br /> 9.1 <br /> D Does parcel meet Zoning Requirements? Yes No <br /> N <br /> ➢ Does parcel require a Survey? Yes No 3 <br /> ao 0 <br /> ➢ Permit application fees submitted? ❑ Amounts Receipt 9z-rlooA <br /> ar <br /> r po <br /> ❑ Reconciles With Real Property Lister Yes NoDate: o c <br /> a <br /> If not,explain: u w <br /> a 60 <br /> N <br /> A O <br /> Application Approv dl/ Denied Reason fir Denial: Al <br /> C <br /> Land Use pte• <br /> 2/18/2003 <br />