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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+55.00/lot <br /> Owner: W AO Debra Pu F'�' A'n <br /> U <br /> Address: &2jC Dea.nIda kk--alIeuLe� n J �/ <br /> ��q7 V1, eojjh(Ljir5 L of M Phone: / IC-5 '8(0r0` <br /> -Zr i 8 <br /> b I _ -1 y6e-1— OI`br-) Oridnal Parcel Information <br /> yV 3 <br /> Parcel Identification #: Section�_TTownship ,SgN/ Range <br /> / z <br /> Original Description (or attach copy): <br /> Al 994of cc. t excewf Av A; zzs ' <br /> 0 <br /> Current Zoning: rloodplair Y/ Wetland&: Z <br /> �• Lake/River Classification: C- Name of Water Body: V`�alt/VLQ ( QJ <br /> w <br /> 0 <br /> P4 <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: � <br /> o <br /> / A <br /> Acres: 1/.U D <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) r <br /> Proposed access to public road: C/] Al G� 1 <br /> Proposed access to public waters to be provided©N: v <br /> If yes, describe access: L AKe LmtS <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> N <br /> °o ➢ Does parcel require a Survey? Yes No n <br /> 0 <br /> aro 3 <br /> ➢ Permit application fees submitted? ❑ Amount S Receipt # °e <br /> re <br /> xt <br /> m ❑ Reconciles With Real Property Lister Yes No Date: o <br /> � P Y <br /> a <br /> if not, explain: <br /> a. <br /> H O <br /> Applicatio Approved / O enied Reason for Denial: ; <br /> c <br /> Land Use: � �G <br /> Date: ' /' <br /> 2/1 A/2003 <br />