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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> Subdivision w/o Survey: $10.00 <br /> and/or Pre-Application Form Subdivision w/Survey: $25.00+$5.0011ot <br /> Owner: aJU <br /> Address: O z Z <br /> Lddl� 71V I �/u 6Q 36 Phone: <br /> oy/oo OriQinalParcel Information A <br /> Parcel Ydentification#: 2 -yo/lo-/y Section Township Range z <br /> Original Description (or attach copy): Al �� �d l /✓� c <br /> P, is 49; 4f VF <br /> 0 <br /> Current Zoning Floodplain Y Wetlands <br /> V (4- 7L <br /> t-' Lake/River Classification: — Name of Water Body: <br /> d <br /> d <br /> New Parcel Information �- <br /> Proposed New Legal Description and Parcel Size: L Cern s <br /> ALL Lots Sltc, + c1 <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. Seepattached for preliminary map requirements.) <br /> Proposed access to public road: �7�y_ Il C1 C <br /> Proposed access to public waters to be provided <br /> A <br /> If yes,describe access: 02) <br /> ➢ Does parcel meet Zoning Requirements Yes No <br /> N <br /> °o ➢ Does parcel require a Survey? Yes No c <br /> o°0 3 <br /> ➢ Permit application fees submitted? ❑ Amount$ Receipt# °e <br /> A <br /> xt <br /> O Reconciles With Real Property Lister Yes No Date: o Q <br /> a ti3 4J <br /> If not,explain: O <br /> N \ w <br /> i <br /> Application Approved / enied Reason for Denial: <br /> w <br /> Land Use: Date: ll'�4-d3 O <br /> 2/18/2003 <br />