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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: _'1-it t�a I C r.4N-1 ate— <br /> Address: _'Z1 QSb $Rq V I'c2 <br /> /W D <br /> e5la&NTSf322,: � WT- 94+8+0 Phone: ` is— "88 Z99A <br /> Original Parcel Information <br /> 3 <br /> Parcel Identification#: 03+ 15^Z1 01 Boo Section Z_Township 3-7_Range I & <br /> z <br /> Original Description(or attach copy): PAVE'- oj= 77t�F N k///4-- or 7 YE <br /> -N tJ 1/4- J <br /> -C <br /> 0 <br /> y Current Zoning: l2fL '? Floodplain Y/N: tJ Wetlands Y/N: `/LS <br /> Lake/River Classification: Name of Water Body: Ajl <br /> m <br /> 0 <br /> Al <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: 4- S R 0120 PAl2ci✓LS <br /> ,1 cs M V go 1 0 �3-He <br /> Acres• <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: d IJ B iAr V I cer/ b V I✓ <br /> Proposed access to public waters to be provided Y IJ d <br /> .. <br /> A <br /> If yes,describe access: <br /> e, ➢ Does parcel meet Zoning Requirements Yes No <br /> e ➢ Does parcel require a Survey? Yes No p o <br /> ➢ Permit application fees submitted? Amount$ y S' Receipt# �8 0 <br /> A <br /> ❑ Reconciles With Real Property ListerYes No Date: O <br /> 06 Q <br /> If not,explain: . P- <br /> C6 V 1 <br /> Applicatio . Approved enied Reason for Denial: <br /> Land Use: - Date: 7 <br /> 2/18/2003 �' v <br />