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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+$15.00/lot <br /> Owner: , ,z boa! �,•� A L�ERAS <br /> Address: 3fo j i pcQpJ K!Al E LS2 1 <br /> 3LCbs�1( n)� rod 1 lel N S�`rJ� Phone: �Z <br /> A <br /> Orieinal Parcel Information <br /> vZ� 3z / g o371 O i3 <br /> Parcel Identification #: v / —3 z I 04noSyection��Township :S!Range t o <br /> Original Description (or attach copy): O <br /> O <br /> F <br /> y Current Zoning: I '?- Floodplain�V: Wetland: <br /> o <br /> '8 <br /> Lake/River Classification: Name of Water Body: �v2bE54tOr <br /> m <br /> New Parcel Informatioo/nI / <br /> Proposed New Legal Description and Parcel Size: <br /> Acres: 3 <br /> (if parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> // tv <br /> Proposed access to public waters to be provided YA�- <br /> If yes,describe access: <br /> v <br /> ➢ Does parcel meet Zoning Requiremen s? No <br /> N A <br /> o <br /> ➢ Does parcel require a Survey? _ Yes-_ No g <br /> ➢ Permit application fees submitted? ❑ Amount$ I 5'0 U Receipt# O X <br /> xt <br /> r0w <br /> ❑ Reconciles With Real Property Lister Yes No Date: �6 <br /> a 1 � <br /> If not,explain: w <br /> / o0 <br /> Applicat pi - Approved / nied Reason for Denial: <br /> 0 <br /> Land Use: Date: <br /> v <br /> 2/18/2003 <br />