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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+$15.00/lot <br /> Owner: j2a N Ai,D S tz Gr-s§G-^1 <br /> Address: 49 a c 3Z h cl AVE S <br /> �t0N IF-APbL'1 3 MIJ 5 5417 - 14-10 Phone: 40 Z. 7Z-9 3 Z Z8 <br /> A <br /> Orieinal Parcel Information 3 <br /> Parcel Identification#: 4 2 2S Z S O+600 Section Z S Township 3 a Range l a o <br /> Original Description(or attach copy): THArr FAal- aF & t_ -7 SGcT1 o N 2 S <br /> C—/tST dF ' f(AJAN Sati1 t?-I> , <br /> O <br /> •o Current Zoning: (Z z 1 Floodplain Y/N: N o Wetlands Y/N: <br /> ��s►� <br /> V o� <br /> m <br /> Lake/River Classification: Name of Water Body Lt TrL+= WoaD L14— <br /> New <br /> ILNew Parcel Information <br /> Proposed New Legal Description and Parcel Size: I LAIl G t.-o r- 1 -7 5 ' 14 W i o Tlf , a <br /> I <br /> 0610 t-AKLr- LOT- ¢.z AcrjTS <br /> 0 <br /> Acres: S,(o A-gZS5 ? <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: 54✓PqJ S e,.1 RP <br /> ff v <br /> Proposed access to public waters to be provided Y/N: N <br /> If yes,describe access: <br /> ➢ Does parcel meet Zoning Requirem ts? Yes No <br /> N _ n <br /> v ➢ Does parcel require a Survey? Y No <br /> B <br /> � D <br /> ➢ Permit application fees submitted? ❑ Amount$ Receipt# <br /> u <br /> m ❑ Reconciles With Real Property Lister Yes No Dat <br /> o e: � <br /> a <br /> If not,explain: <br /> o <br /> a QJ <br /> Vl <br /> Applicata : Approv enied Reason for Denial: <br /> a <br /> L <br /> i <br /> Land Use: Date: J �3 tis <br /> 2/18/2003 <br />