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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:$100.00+$15.00/lot <br /> Owner: �oI–�p ��' I/J�/�rI .^— J'_' r �A K 1.1062G� <br /> Address: 1{2 <br /> �, b pM' P1�,w (�k, f q <br /> I1luf1 (t 11VYl �C �� I Phone: <br /> A <br /> b 17 �2 rifinal Parcel Information / 'g <br /> Parcel Identification#:b U-��C)-CZ' SC Section a5 Township,i /Range <br /> Original Description (or attach copy): L 67 3 C 06M V I /J Z 97 Q <br /> P I" o L C 5m V c7 <br /> p'�X` �CNfa�^y� e exll ��ti, Loi 3 � � <br /> > Current Zoning: R Floodplain(9q: Wetlands 6pq: <br /> g Lake/River Classification: <br /> �Z Name of Water Body: f 2 QT LAkS2J t <br /> m � <br /> + <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: <br /> C:�M A <br /> Acres: �-- <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: r s <br /> t7 <br /> Proposed access to public waters to be providedDY N: LAhti L.r/ A <br /> If yes,describe access: <br /> O <br /> S <br /> N ➢ Does parcel meet Zoning Requirementsc--:Yes No <br /> ➢ Does parcel require a Survey? No 2 <br /> ➢ Permit application fees submitted? ❑ Amount$ //5, D O Receipt# <br /> u <br /> ❑ Reconciles With Real Property Lister Yes No Date: ° w <br /> If not,explain: <br /> o I o <br /> w � <br /> I fi. <br /> C <br /> O G <br /> Application• Approved / enied Reason for Denial: ° <br /> LandUse: � _ Date: � <br /> 2/18/2003 <br />