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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:S100.00+$15.00/lot <br /> Owner: fU A1_ \Jt A A1_z10 ✓y <br /> r ,7932-79(3 Z Cr� )), K rF p� <br /> "' Vy� w i �� /J Phone: `7/6-- ��6%o— q5l <br /> abX7O rpk- <br /> `) t•iei/nal Parc�jel Informati/on , / , / 9 <br /> Parcel Identification#: I b — �J3�1�� S`ectw p Township 39/V Range 114�/ o <br /> Original Description (or attach copy): r2Qc,--hon <br /> I 1� 6YLA <br /> CJl <br /> W <br /> J 0 <br /> Current Zoning: UnlZc" FloodplainY Wetlands N <br /> Lake/River Classification: Name of Water Body: <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: y o T <br /> R'i > <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> C <br /> Proposed access to public waters to be provided Y6) A <br /> If yes,describe access: <br /> ➢ Does parcel meet Zoning Requirements? Yes \ No J1 <br /> N � <br /> °e ➢ Does parcel require a Survey? Yes No ° <br /> � o <br /> ➢ Permit application fees submitted? ❑ Amount$ Receipt# <br /> ac <br /> O <br /> o ❑ Reconciles With Real Property Lister Yes No Date: � <br /> a <br /> If not,explain: G1 <br /> $ fN <br /> E <br /> O <br /> Application: pproved Denied Reason for Denial: Ul <br /> tnt <br /> O <br /> O <br /> Land Use: Date: �7_/9—U5 <br /> 2/18/2003 <br />