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ON COf0PUTER/SCANNcu <br /> Burnett County Subdivision Permit Application Fees(must accompany form): <br /> and/or Pre-Application Form Subdivision w/o Survey: $10.00 <br /> �j J - IPP Subdivision w/Survey:$100.00+$15.00/10t <br /> Owner: �Vr�1�/��� IUCte�IYlPr1Fr ��OT 3 + `� Lam( Grow �C aT c�. <br /> Address: Sq0-(� NY St.,. Lf.isP.aao hIt (Zd. v' 10 P'644 <br /> Va�rlais H-5-Es., ryw <br /> Shae�jlewn nln SJ��(�i Phone: <br /> A <br /> Orieinal Parcel Information � <br /> Oa0-L(3a-7- 07- 5V 5- <br /> Parcel Identification#:ba0- y3a2_07- t5�)(o Section= -�-Township Range <br /> 0 <br /> 070-It3a7-67- __10 <br /> Original Description (or attach copy): l �T a CS rn U, D p, /0 L? <br /> 65 in V. s p, 9) <br /> ��v`E (o (✓ 3 Sic, a7 7_�1©AJ jJlb(_J c <br /> yD Current Zoning: Floodplain <br /> Wetlands <br /> Lake/River Classification: SS Name of Water Body: LD <br /> Y <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: �s oA l <br /> V . P. <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: 'DevI Is <br /> 0 <br /> Proposed access to public waters to be provided Y/N: <br /> A <br /> If yes,describe access: <br /> O <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> N n <br /> ➢ Does parcel require a Survey? Yes No <br /> o'o <br /> ➢ Permit application fees submitted? ❑ Amount$ Receipt# 10 <br /> r w <br /> m ❑ Reconciles With Real c Property Lister Yes No Date: o cs J <br /> If not,explain: Q <br /> 0 <br /> w J J <br /> � O <br /> 1 <br /> Application: pproved / Denied Reason for Denial: (11 <br /> Land Use: /�3d - O R� c <br /> Date: %' < <br /> 2/18/2003 i d � _3� <br />