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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+$5.00/lot <br /> Owner: J6 Cl to v e <br /> Address: o� <br /> 0 1w i' I!1 a r �—t'�t i C Ll e Phone:t 216-3 2W o --4� L 1 <br /> Original Parcel Information A <br /> 3 <br /> Parcel Identification#cjSection Township Township _Range z <br /> Original Description (or attach copy): j }� o <br /> O <br /> a Current Zoning: 4 2 Floodplain Y/N: Wetlands Y/N: <br /> Lake/River Classification: Name of Water Body: <br /> m <br /> 0 <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: <br /> 6 'Aj IC � 'Ief5l c21'40-17 Acres: c <br /> (If parcel is to be surveyed,provide preliminary map. See attached for prelimf43 �ments.) <br /> Proposed access to public road: <br /> Proposed access to public waters to be providedY49 <br /> If yes,describe access: eURN <br /> CMGYAA <br /> l>-) <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> N 2'� <br /> °o ➢ Does parcel require a Survey? Yes O <br /> oma 3 <br /> ➢ Permit application fees submitted? Amount$ Receipt# c <br /> A <br /> �t <br /> r .. <br /> ❑ Reconciles With Real Property Li er �YesNo Date: a C <br /> a <br /> If not,explain: , <br /> 0 <br /> 6 <br /> H N <br /> :112_ / 1 <br /> Application: Approve / Denied Reason fo Denial: LS r Q <br /> LVLand Use: Date: ^I �� 1 <br /> x <br /> 2/18/2003 <br />