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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+$5.00/lot <br /> Owner: 3 o st1 WcL+r <br /> Address: 10-72.3 S;iver t k Ro 0a <br /> G rc i-s 6urA tv x .64 5•ti-0 Phone: (089 - Z 7 9 9 <br /> Original Parcel Information A <br /> 3 <br /> Parcel Identification#: o3`f- 15Z7 bZZoOSection a 9 Township 3-7 Range i 8 <br /> z <br /> / 0 <br /> Original Description (or attach copy): tV, Ln"fx C e t �1t^/ <br /> A ' O <br /> Current Zoni g: -7i Floodplain Y/N: Wetlands Y/N: <br /> °• Lake/River Cla Name of Water Body: <br /> UN <br /> New Parcel Information S <br /> Proposed New Legal Description and Parcel Size: Lo+ I c Sro� <br /> Va a o P. aoa_a,o3 <br /> Acres: 0 23 <br /> (if parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: Y e c-- 4cces_s s �j SLUE <br /> Proposed access to public waters to be provided Y/N: /\j d <br /> w <br /> A <br /> If yes,describe access: <br /> a <br /> i <br /> ➢ Does parcel meet Zoning Requirements. Yes No b <br /> N � <br /> °e ➢ Does parcel require a Survey? Yes No c <br /> ➢ Permit application fees submitted? Amount$-415. OD Receipt # ��` tZ— e <br /> X 6 <br /> x <br /> ❑ Reconciles With Real Property Lister Yes No Date: C> <br /> a � <br /> If not,explain: <br /> 0 <br /> a <br /> H 1 <br /> I <br /> Applicatio =Approve / Denied Reason for Denial: <br /> Land Use: Date: <br /> 2/18/2003 <br />