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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:$100.00+$15-0011ot <br /> Owner: J i1 Ot l SV.dG ' <br /> Address: 9 18 a -Ty CatAor2E L" N <br /> 10pt'E GieOVF- M 1J -55 36!9 Phone: I z- 3'* - 7713 <br /> A <br /> Orifinal Parcel Information <br /> 0113 3335 <br /> Parcel Identification#: O S 1 0o Section 35 Township 39 Range�_ Z <br /> 0 <br /> Original Description (or attach copy): A-Irr-C}I MP <br /> ID <br /> Lir s IT PAnZT or 3 c SM VOL. 1 S P 190 -3 <br /> a Current Zoning: z 1 Floodplain Y/N: 7 Wetlands Y/N: IJ '•`` <br /> bl--I <br /> Lake/River Classification: Name of Water Body: C LA.rn L 14 o <br /> m S <br /> New Parcel Information V} <br /> Proposed New Legal Description and Parcel Size: )Z& - DIVISIOCJ 6F La 1'S <br /> � Z� 3 cSnti Yds- lS 1 P190 <br /> Acres: Z S <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: $ u-NSMy.C-"j'>✓ � <br /> Proposed access to public waters to be provided Y/N: 5'1(ST1 a G <br /> If yes,describe access: <br /> c5 <br /> ➢ Does parcel meet Zoning Requirement . Yes No <br /> °e ➢ Does parcel require a Survey? No 0 <br /> C <br /> 00 <br /> ➢ Permit application fees submitted? 0 Amount$ Receipt# <br /> U <br /> o� <br /> m ❑ Reconciles With Real Property Lister Yes No Date: <br /> VjC6 Ww <br /> If not,explain: w W <br /> 1 <br /> OQ <br /> Application• pproved / D ted Reason for Denial: <br /> Land Use: Date: <br /> 2/18/2003 : <br />