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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> Subdivision w/o Survey: $10.00 <br /> and/or <br /> , P,�re-Application Form Subdivision w/Survey: $25.00+$5.001lot <br /> Owner: 1J_'�''t, `� <br /> Address: -h M � <br /> oin"Al O 30 Phone: <br /> Original Parcel Information <br /> 0�0-�ll�s'as-va� a <br /> Parcel Identification#: Z3` G im //``Section Township ` 0 Range //=� z <br /> P <br /> Original Description (or attach copy): <br /> � <br /> 44 lPo <br /> W� <br /> a <br /> Current Zoning: �� /�� Floodplain Y/N: Wetlands Y/N: �_ 7 <br /> '— Lake/River Classification: — Name of Water Body: <br /> n <br /> 7 7 <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: <br /> C�>n U ao P (oCa- �rJ <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: _C � / �� <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: <br /> ➢ Does parcel meet Zoning Requirements? Yes No c <br /> N � <br /> °o ➢ Does parcel require a Survey? Yes No c <br /> ao <br /> 3 <br /> ➢ Permit application fees submitted? 1 Amount S 1 -36 - Receipt# 7 'e <br /> at <br /> Reconciles With Real Property Lister Yes No Date: <br /> CL w <br /> If not, explain: jr <br /> 0 <br /> H <br /> e <br /> � e <br /> Application: pproved / enied Reason for Denial: <br /> Land Use: Date: <br /> 2/18/2003 C ry <br />