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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> and/or Pre-Application Form Subdivision w/o Survey: $10.00 <br /> Subdivision w/Survey: 525.00+S5.00/lot <br /> Owner: -LL k rw r j ak <br /> Address: ►7; yL/Q o <br /> Phone: 2/6" (q'j�j <br /> Orieinal Parcel Information „d <br /> / 7k--Xoy p S- SOO on 3q W <br /> Parcel Identification#: LcJ. a�py_ ,gppSecti3—�_Township Rang a t 3 <br /> _ <br /> Original Description (or attcopy): <br /> 3 ��I '3�� <br /> attachz <br /> y Current Zoning: R12., I Floodplain � <br /> P �� 2S Wetlands Y/� <br /> 'o A <br /> Lake/River Classification: Clgss / Name of Water Bod <br /> T -- Y: Q t•u <br /> New Parcel Information <br /> Proposed New Legal Description an c.d Parcel Size: II Doa 39 a 7 <br /> -PfC(t / <br /> b� SG�� 6i/ce shote V <br /> Acres: 32 . <br /> Qa <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.)--- <br /> Proposed <br /> equirements.)-_Proposed access to public road: es <br /> c? <br /> Proposed access to public waters to be provided Y// (J_ p °,, <br /> If yes,describe access: "J m <br /> G y2 <br /> ➢ Does parcel meet Zoning Requirements? Y No 1"OB <br /> N ZpNING o <br /> Q ➢ Does parcel require a Survey? ye <br /> No qb. � <br /> ➢ Permit application fees submitted? Amount S( `( <br /> Receipt# o <br /> C <br /> dZ <br /> 5 ❑ Reconciles With Real Property Lister Yes <br /> a No Date: <br /> If not,explain: 4` <br /> Q'i <br /> 0 <br /> Applica ' : Approved / enied Reason for Denial: o <br /> 1 <br /> Land Use: <br /> Date: �S <br /> 2/18/2003 <br />