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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> and/or Pre-A lication Form Subdivision w/o Survey: $10000 <br /> PP Subdivision wl Survry:S 100.00+$15.00/lot <br /> Owner: IN W?-ift Y1(1 pW " d1r, <br /> Address: 1150 C.U. ROo'd <br /> bwrT� WI r04VS0 Phone: 1 (715) (05(0- 3213 <br /> Orieinal Parcel Information B <br /> doo <br /> Parcel Identification#: 3Z-9625-05- SW Section_% Township 41 N Range I(oVJ e <br /> Original Description(or attach copy): �� l.p� 37 t Bed 31 <br /> o lrN W Q un eG L <br /> Current Zoning: _ Floodplain Y& Wetland&: <br /> Lake/River Classification: �� Name of Water Body: <br /> New Parcel Information T <br /> Proposed New Legal Description and Parcel Size: i - 4 ib� C S VIA <br /> � - Csm y lois r� <br /> Acres: 5.9 <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: vA <br /> If yes,describe access: Q)Q <br /> D Does parcel meet Zoning Requirements? Yes No <br /> ➢ Does parcel require a Survey? yes NO 9 <br /> w e <br /> D Permit application fees submitted? ❑ Amount S Receipt# <br /> a <br /> 000 <br /> e ❑ Reconciles With Real Property Lister Yes No Date: Ww) <br /> a <br /> If not,explain: w <br /> Appucatl n: Approved / nied Reason for Denial: <br /> p coo <br /> Land Use: Date <br /> 2118/2003 <br />