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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> Subdivision./.Su cy: $10.00 <br /> and/or Pre-Application Form Subdivisimw/Survey:$1010o+$1S.00not <br /> Owner: J Q N Q6((( iY I('r j <br /> 7� ' I I <br /> Address: &. eciX � I �/ (AC Ep T7Q-fC��(1 U-YI-rE', <br /> � C ��I �`I���� Phone: <br /> 4-4 R h' „ <br /> n <br /> Orieinai Parcel Information // B <br /> Parcel Identification#; 01Y-yZO7- 0 9-W Section I—Township HG ti� Range <br /> Original Description (or attach copy): � L. �/ J?JY <br /> 4U OF re'f CSA1 GC <br /> oa <br /> ppOp <br /> y Current Zoning: ISR 1 Floodplain]'N• Welland Yr / <br /> 9 <br /> 5F _ <br /> Lake/River Classification: Name of Water Body: <br /> m R <br /> ° Bwek Lat s yre •� <br /> ro <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: C� <br /> A <br /> Acres: /• <br /> (If parcel is to be surveyed,provide A preliminary map. See attached for I preliminary map requirements.) <br /> Proposed access to public road: SUIt (D �UCL.CI e'4er <br /> Proposed access to public waters to be provided Y <br /> At A Ljluf' 7-0,- o <br /> If yes,describe access: <br /> G <br /> Q <br /> ➢ Does parcel meet Zoning Requirements? Yes No2. <br /> 6' <br /> e <br /> ➢ Does parcel require a Survey? Yes No 9 <br /> a <br /> � I aa a <br /> ➢ Permit application jeer submitted? ❑ Amount$ 130,00 Receipt# <br /> x <br /> ❑ Reconciles With Real Property Lister Yes No Date: <br /> a If not,explain: <br /> e <br /> n <br /> J <br /> Application Approved Denied Reason for Denial: <br /> Land Use: Date: J�'»F 6 <br /> 2/18/2003 <br />