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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> Subdivision w/o Survey: S10,00 <br /> and/or Pre-Application Form Subdivision w/Survey: $25.00+$5.00/lot <br /> Owner: <br /> Address: Kf 1 2yo <br /> Mpv11r)_. OTz 5gj39 Phone: e?9 — S/?ol <br /> Original Parcel Information A <br /> 341 W ' <br /> Parcel Identification#: /H- a-z0I/-o5-B�Section 3�Township 3O lO Range l_/sem 3 <br /> R1,0-3 33-0t -3vo z <br /> Original Description (or attach copy): V0 D 9 <br /> O <br /> Current Zoning: (.Z R ( Floodplain(2)N: e5 Wetlands Y/0 lj0 <br /> • Lake/River Classification: Oa55 Name of Water Body: 13 t'G sw,d LA/Grt_ �1 <br /> 0 <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: boa. A- <br /> 3'7 <br /> -Plat bF 5eA„d L-a/cr. Sl.orV. S 0,Og <br /> 11 0-L5 Acres: 3 Z . Q, <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.__ <br /> Proposed access to public road: est �J ' <br /> Proposed access to public waters to be provided Y$�- qD <br /> If yes,describe access: G _ <br /> ➢ Does parcel meet Zoning Requirements? Y No d ZoAING O <br /> N <br /> Q ➢ Does parcel require a Survey? Ye No qb, QD <br /> ➢ Permit application fees submitted? Amount$ a .�� Receipt# <br /> A <br /> r # <br /> ❑ Reconciles With Real Property Lister Yes No Date: Q <br /> CL. <br /> If not,explain: Uj Q,Q; <br /> R1 Sit Al <br /> CL <br /> _C <br /> C <br /> I � <br /> _ O <br /> Applica ' Approved / enied Reason for Denial: ( I' <br /> 91 <br /> Land Use: 7?0�jldry 6)fn ) P'�' Date: IN/0- <br /> 2/18/2003 <br /> 0-2/18/2003 <br />