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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+$5.0Ur <br /> Owner: /h ,16j1G jjL M1Z/_.5 <br /> Address: JD3gy// Al y� <br /> J�-��f/h-f3-(��JL�-f, li l Phone: 6�56` y568 <br /> 32-gi5a5- 6 1- 10© Orieinal Parcel Information ro <br /> l� � <br /> Parcel Identification #: Section o l Township Llll Range �✓ <br /> z <br /> 0 <br /> Original Description (or attach copy): SZP t <br /> O <br /> nn n O <br /> 9 Current Zoning: h R 2 Floodplain YO Wetlands Y(E) <br /> "-� Lake/River Classification: Name of Water Body: <br /> m <br /> 0 <br /> f1 <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: C 5/n Po -t- L4T I N W 'ly <br /> _MW/'l/' Nir 1/N N E lq N vjlLl CSm VOID <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: qCLVI <br /> IJ , <br /> Proposed access to public waters to be provided Y6 <br /> If yes, describe access: <br /> -� <br /> N ➢ Does parcel meet Zoning Requirements? Yes No R ST-r <br /> °o ➢ Does parcel require a Survey? C--ryes No <br /> NG <br /> ➢ Permit application fees submitted? Amount$ 5 DD Receipt # Ssq'] e <br /> at <br /> Reconciles With Real Property ListerYes No Date: Q <br /> a <br /> If not, explain: <br /> � I <br /> a <br /> W <br /> Applicatio Approv ^! Denied Reason for Denial: <br /> O <br /> Land Use: Date: <br /> 2/18/2003 O <br />