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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 FormSubdivision w/Survey: $25.00+$5.00/lot <br /> Owner: �j) / / -4S/es <br /> Address: 50�1 9 1411/P/YU P /40RVwP5'l <br /> /1�eGt� 1s7�( i la'/l70/t , �iY Ssf�� Phone: <br /> Ori final Parcel Information A <br /> // /'/ D <br /> Parcel Identification#: Q (D X029 Section0' 4 Township Ila Range �� 3 <br /> _ z <br /> r // o <br /> Original Description (or attach copy): AI)Q SC S(,/f S�� S` P <br /> SF 5w o <br /> n O <br /> Current Zoning: /') ' Floodplain /N: Wetlands /N: <br /> Lake/River Classification: Name of Water Body: d 0 <br /> d <br /> 0 <br /> New Parcel Inforrm�ation <br /> Proposed New Legal Description and Parcel Size: 1f' YC2 s'F s <br /> Acres: CA <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> Proposed access to public waters to be provided Y/N: d <br /> A <br /> If yes,describe access: J <br /> r <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> !!!!!N - <br /> 00 ➢ Does parcel require a Survey? Yes No�j_ c <br /> ➢ Permit application fees submitted? ❑ Amount$_ /(/ Receipt # <br /> A <br /> r <br /> x <br /> ❑ Reconciles With Real Property Liste Yes No Date: U Q <br /> a <br /> If not, explain: <br /> o <br /> a <br /> W <br /> N <br /> Application: Approved / enied Reason for Denial: <br /> Land Use: Date: r <br /> 2/18/2003 <br />