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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+$15.00not <br /> Owner: ' 'd // r� <br /> Address: ��`�c3�}0 iza �� 4/ Phone: _ 3j t�Cgz <br /> i <br /> A <br /> Oriainal Parcel Information 9 <br /> Parcel Identification#: Section Township Range �� o <br /> Original Description(or attach copy): /, ,� .Z r /_ /s i 2 O <br /> Q /V <br /> r 'n <br /> „ Current Zoning: ��/� Floodplain Y/N: Wetlands YIN: _ <br /> q <br /> 2 La <br /> m <br /> ke/River Classification: » Name of Water Body: xs e � <br /> m <br /> p <br /> New Parcel Information <br /> nn � <br /> Proposed New Legal Description and Parcel Size: <br /> Acres: —), <br /> (If parcel is to be surveyed,provide preliminary map(. See attached for preliminary map requirements.) <br /> AlyProposed access to public road: / r r fjti�" <br /> v <br /> Proposed access to public waters to be provided Y/N: �_ A <br /> If yes,describe access: C <br /> ➢ Does parcel meet Zoning Requirements? des No <br /> N f1 <br /> ➢ Does parcel require a Survey? No 9 <br /> w o <br /> ➢ Permit application fees submitted? ❑ Amount$ Receipt# <br /> x <br /> r <br /> e ❑ Reconciles With Real Property Lister Yes No Date: <br /> a <br /> If not,explain: <br /> h � <br /> I <br /> Q <br /> Application Approv Denied Reason for Denial: <br /> O <br /> a <br /> Land Use: Date: —�� G <br /> 2/18/2003 <br />