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Burnett County Subdivision Permit Application Fees(must accompany fonn): <br /> Subdivision w/o Survey: $10.00 <br /> and/or Pre-Application Form Subdivision w/Swvcy:S100.00+S15.00/lot <br /> Owner: pALC CHCLL- AtJD Or0t=2 <br /> Address: 39oz oEsr 415t T2s rT <br /> J/00-0%/,j <br /> SIOUX FALLS r Scun+ /DA K C,r-A Phone: loos 361 Zz7Co <br /> A <br /> Orieinal Parcel Information 3 <br /> Parcel Identification#: d 4Z ZS-4-7 o 2 Zoo Section Z'7 Township 3S Range I r6 e <br /> Original Description(or attach copy): f AQT- of 6 eVE424Q M ENT- Lc -19- <br /> > <br /> y Current Zoning: PZ (Z- Z Floodplain Y/N: tl Wetlands Y/N: tJ <br /> Lake/River Classification: /I/ Name of Water Body: IV1 o <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size i u/o 3 Lc c t2r1 FI r=D <br /> S'2JCy MAPS + I Oc1- LcT TD BF bZC]]1=-j> T3 G <br /> t <br /> VJoeD /ZIvGfZ <br /> Acres: 10 + ''h <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: N c2THSW C..12_a pie)v j <br /> 0 <br /> Proposed access to public waters to be provided Y/N: IQ A <br /> If yes,describe access: 9.) <br /> �x <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> N � <br /> ➢ Does parcel require a Survey? Yes No ° <br /> 0 3 <br /> � e <br /> ➢ Permit application,fees submitted? ❑ Amount$A 0• 00 Receipt# <br /> ac <br /> mo <br /> � ❑ Reconciles With Real Property Lister Yes No Date: I <br /> a <br /> eIf not,explain: <br /> a � <br /> Applicata App rov / Denied Reason for Denial: <br /> N <br /> Land Use: Date: <br /> d y� c <br /> 2/18/2003 <br />