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10/10/2005 14:20 3492166 B C ZONING PAGE 01 <br /> Burnett County Subdivision Permit Application FM(must ammpany ford): <br /> SuMvision who Survey' $10-00 <br /> and/or Pre-Application Form Subdivisimwisurvey-sm0.0o+Sls.00na <br /> n ) ( LQaE <br /> Address: awe 36-�K A14 -7D Phone; <br /> as <br /> OriefualParcel Information �J u� a <br /> �TwcfC. }X <br /> Parcel Identification#: 634-15356;tn I Section � Township 3 WRran^ge, __ p <br /> Original Deacri tion(or attach copy)! S �U00V t'� VT 4+"e-. e y <br /> Current Zoning: Moodplain Y® Wetlands YQ L <br /> Lake/River Classification: NIA Name of Water Body: <br /> New Parcel Ioform!42a <br /> Proposed New Legal Description and Parcel Size: `lQQ at'�. <br /> �1 <br /> Acres: c�X)O jrC <br /> (If parcel is to be surveyed,provide preliminary map See attached for preliminary map requirements.) <br /> Proposed assess to public rostd: t Q.� <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: Q <br /> D Does parcel meet Zoning Requirements? Yes No <br /> ➢ Does parcel require a Survey? Yes No <br /> D Permit application fees submitted? ❑ Amount$ Receipt# <br /> 4e <br /> ❑ Reconciles With Real property LuteYes No Date <br /> a If not,explain: <br /> pp <br /> Applicatio Approve / Denied Reason for Denial: y� <br /> _o <br /> d <br /> Land Use: Dam: /a �7 —C/� <br /> 2/Ish003 <br />