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Burnett Count Subdivision Permit Application <br /> E(mustompany form): <br /> yo Survey: $10.00 <br /> and/or Pre-Application Form Survey: $25.00+$5.00/lot <br /> Owner: � ^' /1 <br /> Address: 9^�1�a"�Ol �" /�` (i <br /> hQ S 3 3 Phone: .-Z— 77V— ZZ/ <br /> ro <br /> Ori final Parcel Information <br /> p 3 <br /> Parcel Identification M 018-331 - 0 /63Sao Section y Township 3 / Range z <br /> % <br /> Original Description (or attach copy): E>e44 <br /> :o <br /> J <br /> O <br /> a <br /> Current Zoning: I Floodplain Y/N: /�/ Wetlands Y/N: A <br /> '— IA- <br /> Lake/River Classification: Name of Water Body: /V <br /> n <br /> m <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: <br /> S s F'k v VeN <br /> P (_ L Acres: I� <br /> (o <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> Proposed access to public waters to be provided Y/N: d <br /> A <br /> If yes,describe access: <br /> r <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> N f7 <br /> ➢ Does parcel require a Survey? Yes No 0 <br /> 3 <br /> a <br /> ➢ Permit application fees submitted? ❑ Amount S Receipt # <br /> d Reconciles With Real Property Lister Yes No Date: <br /> Ll p <br /> a Cn <br /> If not,explain: W <br /> o (N <br /> H <br /> Ap ication: Approved / enied Reason for Denial: W <br /> Date: — 3, c <br /> Land Use: <br /> -)S <br /> 2/18/2003 <br />