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Burnett County Subdivision Permit Application F=s(must accompany form): <br /> Subdivision w/o Survey: SI0.00 <br /> and/or Pre-Application Form Subdivision w/Survey:$100.00+$15.110/lot <br /> Owner: /D 10jrI"Q- A e d a g/i o. <br /> Address: (df 'A <br /> wcb5he', W1 5yg93 [�Phone: �1t3- 866- 16LJ <br /> Original Parcel Information 'a <br /> Parcel Identificatlou#:SUIS"33x3-olJoo Section_Township39./ Rangel o <br /> Original Description(or attach copy): ALL OF L bT- 3, CSM V6 <br /> Q� <br /> C' 280 - PSI - 6. L. Z amd �)a* oX C. L . l <br /> �Xis�rH� fa�c, l E <br /> y Current Zoning: Poo Floodplain'�N: WetlandsC�N: .'. <br /> '- Lake/River Classification: Name of Water Body: Oe t/i I J (k K - b <br /> 'm <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: <br /> Acres: /•2 7 t <br /> (if parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: C . T-. H , A <br /> d <br /> Proposed access to public waters to be provided <br /> r <br /> If yes,describe access: �✓1 s L .+ <br /> Vi <br /> ➢ Does parcel meet Zoning Requirement . Yes No G` <br /> a ➢ Does parcel require a Survey? Yes, No °g <br /> A ➢ Permit application fees submitted? ❑ Amount$51 D D Receipt# 8717 S <br /> a <br /> rO <br /> ElReconciles With Real Property Lister Yea No Date: — C�- <br /> a � <br /> R If not,explain: CN CU <br /> � w W <br /> O <br /> Applicatio rx Approve / Denied Reason for Denial: <br /> o d <br /> c G <br /> Land Use: Date: <br /> 2/182003 <br />