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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> Subdivision w/o Survey: $10.00 UU <br /> and/or Pre-Application Form Subdivision w/Survey: $3.5:bf)+S�410t <br /> Owner: ICU <br /> 1/p�Vl C (,!(,Ut <br /> Address: <br /> 42 L_ jF30 Phone: <br /> Ori final Parcel Information 'o <br /> MC_5 3 <br /> Parcel Identification #: 03(0—4{O3—OL700Section Q Township 'y0 Range / <br /> bib-y40 IS,J� <br /> o <br /> � <br /> Original Description (or attach copy): yV `f Gtr, <br /> 5�S IA/ - 4D aC) <br /> p � 0 <br /> Current Zoning: �— Floodplain Y/N: !y Wetlands Y/N: <br /> V A <br /> d <br /> Lake/River Classification: N Name of Water Body: — <br /> 0 <br /> .Sim aft <br /> '_ _J New Parcel Information �p <br /> Proposed New Legal Description and Parcel Size: 1 oZU 0-c- 0a ,C5 i 0 .�05 W/ <br /> 2 to a-c, Q- lots <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.)/V <br /> Proposed access to public road: 0-h fttb T��,)Ver kcL <br /> Proposed access to public waters to be provided Y/N: /V p <br /> d <br /> If yes, describe access: <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> N <br /> °o ➢ Does parcel require a Survey? Yes <br /> o <br /> °Q 3 <br /> ➢ Permit application fees submitted? #\ <br /> Amount$ , Receipt# 380 <br /> e <br /> ^. <br /> A <br /> r <br /> ❑ Reconciles With Real Property Lister Yes No Date: p <br /> a <br /> If not,explain: <br /> o I <br /> a a <br /> 1 <br /> Applicatio =Approved)Denied Reason for Denial: 0 <br /> Land Use: Date: <br /> 2/18/2003 <br />