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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+$15.0011ot <br /> ' <br /> Owner: U rG�2 1 \ �- 4c-J- gQ S <br /> Address: Phone:�=�d �' I/ 7 � <br /> Lt/ Phone: <br /> A <br /> Original Parcel Information 3 <br /> /_ 300 <br /> Parcel Identification#: d I cl/ -3V/5-63- se/ction�—Township 3 T Range <br /> Original Description(or attach copy): S w I y s��� ( pec_ 1 7391t-I R/9� <br /> 1 <br /> Current Zoning: UN Floodplain Wetlands Y/N: <br /> 'o <br /> ° Lake/River Classification: /v Name of Water Body: <br /> New Parcel Information// <br /> Proposed New Legal Description and Parcel Size: ��t/ i <br /> eX P�fw� -t s I <br /> L <br /> &c-��, 7-3�� t /7 Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: ic_ <br /> d <br /> m <br /> Proposed access to public waters to be provided <br /> J <br /> If yes,describe access: R� <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> N c <br /> ➢ Does parcel require a Survey? Yes No G <br /> vo ^� <br /> ➢ Permit application fees submitted? ❑ Amount$ %0 y Receipt# <br /> x <br /> r ,� O <br /> ElReconciles With Real Property Liste Yes <br /> M No Date �S m <br /> W <br /> If not,explain: <br /> C6 <br /> N <br /> W <br /> 1 <br /> Applicatio . Appro / Denied Reason for Denial: W <br /> C� <br /> O <br /> Laud Use: Date: r? <br /> 2/18/2003 <br />