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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: (`jp�.i/'0d / TesChke, <br /> Address: //�� p�� IL V V'k'jT-1jjoOQ tl`f P'(. Vk /S <br /> & I(11!✓VL i' curl 554)6 Phone: <br /> Z Z3 Ll Cojcf3i i%t R66LA <br /> Original Parcel Information A <br /> o Zt0-3 zoz-Ol- 3vv o7Zdv /3I, 1f 3 <br /> Parcel Identification#: 2Section Township Range <br /> z <br /> Original Description (or attach copy): <br /> C DAA e 1�kn dnea � <br /> oa <br /> p 0 <br /> Y Current Zoning: l� 2 Floodplain&I: Welland <br /> ON: <br /> � /�, �J <br /> Lake/River Classification: GJJ Z. Name of Water Body: /tl � L&&L� _ <br /> m <br /> New Parcel Information p /� <br /> Proposed New Legal Description and Parcel Size: lln. <br /> 7 ti 1� 4 New CS12-7 <br /> 4e(lfl '.Skn V I`"( Acres: 4.4r- <br /> (if <br /> parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: { <br /> Proposed access to public waters to be provided <br /> J � <br /> If yes,describe access: Oci �j <br /> i <br /> 93 <br /> N ➢ Does parcel meet Zoning Requirements? Yes No .ZO ISG UN7'y <br /> E. ➢ Does parcel require a Survey? Yes No c <br /> ao / o <br /> ➢ Permit application fees submitted? Amount $ 3-� Receipt # S 30( e <br /> A <br /> t <br /> a <br /> Reconciles With Real Property ListerYes No Date: Q <br /> a <br /> M if not, explain: 1 <br /> 0 <br /> c. <br /> (V(�� Qr <br /> y O <br /> Applicatio<Approved / enied Reason for Denial:1�1 A14 <br /> d� <br /> J � <br /> Land Use: Date: <br /> 2/18/2003 <br />