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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 wlSurvey: $25.00+$5.00/lot <br /> GOwner: EG v dotoh l 9y�'lhJoh <br /> Address: .3j4z3 A1,r Aoo( <br /> .041v gc, W's Phone: Z'rz-7g179 <br /> 3z- S219 —(01900 Original Parcel Information ro <br /> �3 eo 3 <br /> Parcel Identification #: 6 0 4�Section�11_Township �� Range� z <br /> Original Description <br /> s ription (or attach copy): QI 0 Gov( L.e7 A14C N W <br /> uhdusEw ►v CD <br /> a <br /> > Current Zoning: R 2 Floodplain Y/N: Wetland(qN: <br /> v � <br /> Lake/River Classification: Name of Nater Body: — LI <br /> 0 <br /> s <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: Couh f se &1f ��SLe yr 2.Sae — <br /> U. <br /> 1\ <br /> Acres: 5A Ac + 01 <br /> (if parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: S�•✓n <br /> Proposed access to public waters to be provided Y fV: mG <br /> A <br /> If yes, describe access: <br /> ➢ Does parcel meet Zoning Requirements? }'es No U} <br /> N <br /> 00 ➢ Does parcel require a Survey,? }'es No f1 <br /> e 9 o <br /> ➢ Permit application fees submitted? Amount $ 3/Q. Receipt # <br /> � W <br /> a 9� <br /> ❑ Reconciles With Real Property Lister Yes No Date: p V <br /> oIf not, explain: <br /> y � � <br /> 0 <br /> Applicatio Approve / Denied Reason for Denial: <br /> '7P <br /> LA <br /> � 8 <br /> Land Use: LDnI DYYIYYI/ <br /> Date: <br /> c ' <br /> 2/18/2003 <br /> U <br />