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JBurnett County Subdivision Permit Application s��any fnTl <br /> Subdivision w/o Survey: $10.00 <br /> and/or Pre-Application Form u rvisionw/Survey: .00+$5.00/lot <br /> Owner: i�, <br /> Address: f7 X51/, lyo e t✓Z-� ,5r- ,tom K c <br /> -SA e- t,Ji ' S 4/8?Z Phone: / 4,-' Z <br /> Original Parcel Information <br /> Parcel Identification#: Sechon as Township 319 <br /> RanS 3 <br /> S <br /> Original Description (or attach copy): IQ % <br /> V.1 <br /> ' I O <br /> Curren ?oring: uh2&OeJ Floodplain Y/10`: �) Wetiands Y/N: ' <br /> _ bldg srk �.Jo , <br /> Lake/River Classification: Name of Water Body: — be >q6' <br /> 0 <br /> 4 S <br /> New Parcel Information , f <br /> Proposed New Legal Description and Parcel Size: 0 S /v s l6 UG <br /> N(_C s E)(c, S 30 4c, <br /> 6l TO - <br /> Acres 30 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for prelimin arequirements.) <br /> Proposed access to public road: <br /> Proposed access to public waters to be provided Y/N: MA <br /> If yes, describe access: �" 3 � I <br /> if 1A <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> NG <br /> N <br /> °o ➢ Does parcel require a Survey? Yes No c <br /> o' <br /> ➢ Permit application fees submitted? I Amount$ /0-06 Receipt # 57,31 <br /> o <br /> c <br /> A <br /> x <br /> ❑ Reconciles With Real Property Lis Ye No Date: Q <br /> o <br /> If not, explain: <br /> o � <br /> 'a J1 <br /> H <br /> Application: (r roved;/ Denied Reason for Denial: <br /> Land Use .._� "` rtljz'� Date: <br /> W <br /> 2/18/2003 �f <br />