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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:S100.00+$15.00/lot <br /> Owner: /?j A l-yD/✓ <br /> Address: 3 3 96 'Ajr1zV# LAKt=S.Yo"o PR- <br /> (All L Phone: .99 4-7 3 <br /> A <br /> OriainalParcel Information <br /> Parcel Identification#:C7-4V "4-543--0330'gection 3 Township :�o Range , o <br /> Original Description (or attach copy): 57EE <br /> O <br /> y Current Zoning: _9/L -'Z Floodplain Y/N: Wetlands Y/N: <br /> Lake/River Classification: !iL/!55 Z Name of Water Body: �o✓� �I�.+L+ic <br /> m � <br /> Q <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: 4igE Asftwiel 1�yy7�clyB S <br /> Acres: 5__ <br /> (If parcel is to be surveyed,provide prelimina map. See attached for preliminary map requirements.) <br /> Proposed access to public road: D <br /> 0 <br /> Proposed access to public waters to be provided Y/N: /4 A <br /> If yes,describe access: <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> N n <br /> °e ➢ Does parcel require a Survey? Yes No B <br /> r <br /> � C <br /> ➢ Permit application fees submitted? ❑ Amount S Receipt# <br /> u <br /> r a <br /> ❑ Reconciles With Real Property Lister( Yes No Date: 5 <br /> a � <br /> If not,explain: �y " <br /> o W <br /> Q <br /> Application: Approved / Denied Reason for Denial: w <br /> O <br /> O <br /> Land Use: Date: <br /> 2/18/2003 <br />