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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:$100.00+$15.00/lot <br /> l` S 0o <br /> Owner: _ PE,jN 15 ct EEA <br /> Address: 019319, N D a ri l- 5^1 L t✓V TZ <br /> 17PN V30 r?v WT 54 3 o Phone: _71 S KoS Cp q-I z¢- <br /> Orieinal Parcel Information 3 <br /> Parcel Identification#: <br /> lo 441 S d 1 50e Section Township�_Range- ::j c <br /> Original Description(or attach copy): 15 '/Z O i- S11Z N YJ '/4 t\1 W '14 <br /> G <br /> a <br /> O <br /> 9 Current Zoning: P__2 Floodplain Y/N: n/ o Wetlands Y/N: N D <br /> Lake/River Classification: rJ / <br /> m / Name of Water Body: NIA <br /> J <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: 3 i_aT- e S M <br /> o 4 47,4mof6 � <br /> S�it R 1TA.c►-I GP 5KG7-c + Acres: 0-0 A- Ta T-AL <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: y G S <br /> d <br /> Proposed access to public waters to be provided Y/N: N o <br /> A <br /> If yes,describe access: <br /> a <br /> ➢ Does parcel meet Zoning Requirements? Yes No '1 <br /> N A <br /> ➢ Does parcel require a Survey? Yes No ° <br /> o' � <br /> Permit application fees submitted? ❑ Amount$ Receipt# <br /> r 'Q <br /> ❑ Reconciles With Real Property Lister Yes No Date: W <br /> a � <br /> If not,explain: <br /> oa <br /> y <br /> Application: Approved / Denied Reason for Denial: 1_ <br /> G <br /> Land Use: Date: <br /> 2/18/2003 <br />