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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+$5.00/lot <br /> Owner: <br /> Address: ry�10� 9��6 l'/�ml ey kJ6y, 96�- )Y)3 <br /> Phone: '7o- 656-r3zN <br /> / Original Parcel Information 00U /� , <br /> Parcel Identification#: �_7//'' 4_36'6 b Otion�Township y�N Range//PyV/ 3 <br /> z <br /> Original Description (or attach copy): <br /> V q9 <br /> 0 <br /> Current Zoning: Floodplair�Y�N: Wetlan s <br /> q <br /> m <br /> Lake/River Classification: 0ZName of Water Body: /hiA1&r4/Q ZkA-e� <br /> New Parcel Information 31 <br /> P gDescription <br /> Proposed New Legal and Parcel Size: <br /> Acres: 53 <br /> (If parcel is to be surveyed,provide preliminary /map. See attached for preliminary map requirements.) <br /> Proposed access to public road: //6 U'A 161V <br /> Proposed access to public waters to be provided Y& o <br /> w <br /> If yes, describe access: LA k-c L,>,r f0 <br /> i <br /> O <br /> ➢ Does parcel meet Zoning Requirements? Yes No 0 <br /> -tt � <br /> ➢ Does parcel require a Survey? Yes No n <br /> ° o <br /> ➢ Permit application fees submitted? ❑ Amount$ Receipt# <br /> w <br /> A <br /> Z <br /> r x� <br /> ❑ Reconciles With Real Property Lister Yes No Date: <br /> a � <br /> If not, explain: y, <br /> o � <br /> a v? <br /> H <br /> W <br /> W <br /> Applicata . Approv / Denied Reason for Denial: a <br /> J <br /> a <br /> 0 <br /> Land Use: Date: D �/a'-d y <br /> 2/18/2003 <br />