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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+$5.00/lot <br /> Owner: &&h&e_1 /Y 'V/ S(fAZ <br /> Address: /l g S Ca r S CA /4 - <br /> SG'o o P d C.�r 9V8,6/ Phone: 7,15--6 3 <br /> Original Parcel Information A <br /> ' 2 �1 3 <br /> Parcel Identification#: U �$-q/13-0 O_L)Section Township 40 Range T <br /> c 0 <br /> Original Description (or attach copy): ?-ele <br /> ^/ O <br /> 9 Current Zoning: Floodplain Y/N: i(/0 Wetlands Y/N: 0 <br /> � '• <br /> Lake/River Classification: Name of Water Body: <br /> d <br /> e <br /> New Parcel Information �iAl►l� /�wYtP d h +t n <br /> Proposed New Legal De cription and Parcel Size: O <br /> futiLP/. aaen� unYB� t-o-t 7q r, _6 Fs S <br /> W <br /> t <br /> Acres: s. - <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) 1 <br /> Proposed access to public road: &rh �1 pri�/G�(� -,ea-atiY>9 -d-s r,6yl' ✓1f <br /> Proposed access to public waters to be provided Ptl+- 15dyl )Aad <br /> �(( l o <br /> L-�Wegern P� s not do ly <br /> If yes,describe access: h�shaYP� <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> N C <br /> e ➢ Does parcel require a Survey? Yes No c <br /> ➢ Permit application fees submitted? Amount$ ID. O0 Receipt# -�3 7 l r <br /> A <br /> , <br /> a <br /> ❑ Reconciles With Real Property L'Cter�Ye NoDate: <br /> a � <br /> If not, explain: r r <br /> a '\ <br /> N <br /> W <br /> Applicatio . Approved Denied Reason for Denial: <br /> fi <br /> Land Use: <br /> s�Str T Zi�- Date: �s 0° C <br /> 2/18/2003 <br />