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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+$5.00/lot <br /> Owner: �� 0. _tUhtJ56N <br /> Address: Ifo4Cl <br /> Qui bwr , V I 5gg36 Phone: 115-656 - 7919 <br /> Orieinal Parcel Information <br /> Parcel Identification#©-:L) -5:2/3-0 �gection �J f �� Township WN/ Range <br /> (� A <br /> z <br /> L. l Sic /3 7— <br /> Original Description(or attach copy): �, y/N R/401 <br /> N /2 /5 ►�% <br /> 0 <br /> Current Zoning: Floodplain Y/N: Wetlands Y/N: <br /> '— Lake/River Classification: (,-/a55 3 Name of Water Body: <br /> m <br /> 0 <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: / <br /> O,S M V "/ ��`! "� `7� � d m Acres: b. <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: 6a55 L1q710/ d-d <br /> Proposed access to public waters tn ' <br /> o be provide : d <br /> If yes,describe access: �+� A�Sf 0� Ob t lel d- o <br /> 1 <br /> AJ <br /> tv ➢ Does parcel meet Zoning Requirements? Yes No `p <br /> °o ➢ Does parcel require a Survey? �Y � No e <br /> ' 3 <br /> ➢ Permit application fees submitted? J�J/ Amount$ � Receipt# e <br /> A <br /> �t <br /> Reconciles With Real Property Lister es No Date: a <br /> a Va <br /> If not,explain: �1 <br /> a <br /> Vl <br /> 1. <br /> Application: Approv ! Denied Reason for Denial: d <br /> Land Use: Date: <br /> 2/18/2003 <br />