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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+$5.00/lot <br /> Owner: �, ;w, M,t(e— <br /> Address: P. o . 3 a X 3 9 <br /> St. CCu ra-tt wL J ziozLj Phone: -7 _yff� -3339 <br /> Original Parcel Information A <br /> 3 <br /> Parcel Identification#: n z u 9 iQ� , ,.3 v c I Section I Township 4 o Range i_ <br /> 0 <br /> Original Description (or attach copy): o 2 o cA z o c w I Le c o v z.Ir-g z o C, ,s ti 00 , <br /> ozugzc� � , ssuc� <br /> L_ot"S I o -14 'Te.n ci..,'S I...Qk es{l'Y& L7;V1 S';n L9 y <.Lk&P LCAJ6 c C,CL.Io}•S SQc. r`i� d -/{� •� <br /> Y Current Zoning: -p,R i Floodplain YO ,y 0 Wetlands Y® n <br /> �• Lake/River Classification: 1 Name of Water Body: '�l c to „ L..k Q <br /> d <br /> 0 <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: 3 y c s cam, cis <br /> Ci vyi S.L. ycn" <br /> C -1 ��/- (��/ Lao I = Cl•53-'sm V ao ! (l!/" l / Acres: 6•or2- o•�y `— <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: n1 R <br /> Proposed access to public waters to be provided Y/N: .v <br /> If yes, describe access: (( ,, <br /> c�V <br /> J <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> N <br /> o ➢ Does parcel require a Survey? Yes No c <br /> °Q n /�' a <br /> ➢ Permit application fees submitted? Amount$ ( ,21�1, vU Receipt# � e <br /> A <br /> x� <br /> r <br /> Reconciles With Real Property ListerYes No Date: <br /> 06 ( <br /> MIf not, explain: <br /> 0 <br /> CL <br /> Applicati((n�Approved / enie Reason for Denial: w <br /> Land Use: Date: <br /> 2/18/2003 <br /> Y <br />