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4 <br /> 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+$5.00/lot <br /> Owner: <br /> Address: Nf 12 y 0 e/O�' S 6 Yt <br /> M pyn l (�z 5q?3 9 Phone: 715 63-72 — Q?7 <br /> Original Parcel Information A <br /> Parcel Identification M /4- aA04/-q5-B4DOSection 4 Township 36 Ij Range t� <br /> ;j(0-3a33-0j <br /> Original Description(or attach copy): Uo SO(oICI �D r°3 <br /> s <br /> O <br /> Current Zoning: T),g, ( Floodplaine'N: 2S Wetlands Y/(9 NU R <br /> Lake/River Classification: CIASS�/ Name of Water Body: 13 <br /> d <br /> e <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: DOC-. <br /> Imo' �Gct bF SGind L6iIGL. S 4,0 rv,,s U. S 12�aaSB <br /> /?) 11 d-Ls Acres: 3 2 . 63 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements._, <br /> Proposed access to public road: es <br /> P,' ! <br /> Proposed access to public waters to be provided Y/� N D t� � C <br /> If yes,describe access: G <br /> ➢ Does parcel meet Zoning Requirements? Y No �� Zo�1r1G' o <br /> N <br /> Q ➢ Does parcel require a Survey? Ye No qb, ODg�� o <br /> 3 <br /> ➢ Permit application fees submitted? Amount$ Receipt# <br /> A <br /> r # <br /> ❑ Reconciles With Real Property Lister Yes No Date: <br /> a <br /> o If not,explain: <br /> 96 W <br /> a q � <br /> I � <br /> _ o <br /> Applica ' Approved / enied Reason for Denial: � <br /> Land Use: 2�iJ 1 r (T�l Y)✓11/ (J� Date: f ToS <br /> 2/18/2003 <br />