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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:$100.00+$I 5.0011ot <br /> Owner: --(-6G/ Za- d Z2 fGL ae1A..'0W,1* �/�d�•-s <br /> Address: =14%003 <br /> Phone: '; o <br /> A <br /> Original Parcel Information 3 <br /> Parcel Identification#: t3 // (sf�ftion /(' Township Range /S' o <br /> Original Description (or attach copy): <br /> lA <br /> O <br /> Current Zoning: OA.- P4d Floodplain Wetland Y <br /> g Lake/River Classification: /�1 v tT Name of Water Body: A, Q <br /> New Parcel Information / L <br /> Proposed New Legal Description and Parcel Size: /Q �� ` - O"f`r / <br /> Ma Icy We Wo(zd r <br /> t <br /> Acres: __f6e�, 3 o <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: TO w�_ ;�'>Q {moi dwfi <br /> v <br /> Proposed access to public waters to be provided A <br /> If yes, describe access: <br /> ➢ Does parcel meet Zoning Requiremen Yes _� No <br /> N o <br /> ➢ Does parcel require a Survey? Yes No g <br /> 5 0 <br /> �U�SL�J <br /> ➢ Permit application fees submitted. Amount$ Receip t# 3 <br /> ❑ Reconciles With Real Property Lister Yes No Date: <br /> a <br /> � If not,explain: <br /> n <br /> o <br /> a <br /> H I] <br /> 1 <br /> Applicata : Approved / enied Reason for Denial: J <br /> Gt <br /> Land Use: Date: <br /> 2/18/2003 <br />