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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+$5.0011ot <br /> Owner: 56CLUDEQ Lg/iID ('L <br /> Address: �Z IgVeA'la�L !l/ <br /> 7/�/lJ7l lrUi 'y8/-�— Phone: 7/�" J�J'7—J77co <br /> Original Parcel Information d <br /> Parcel Identification #: 6 '"(So2/—(SQ 3681 n o2� Township Range z <br /> � U C / o <br /> Original Description (or attach copy): (�.L J L-0']` <br /> s <br /> 0 <br /> Current Zoning: Z Floodplain�N: <br /> g <br /> Lake/River Classification: I Name of Water Body: <br /> �• fication: <br /> m <br /> New Parcel Information �7 <br /> Proposed New Legal Description and Parcel Size: e.51,n Pa�I3-a/L) <br /> Acres: y� <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: C, :r' /�. Z <br /> Proposed access to public waters to be provided Y/N: d <br /> A <br /> If yes, describe access: <br /> ➢ Does parcel meet Zoning Requirement Yes No Qi <br /> N <br /> o ➢ Does parcel require a Surrey? Yes No e <br /> °Oa <br /> ➢ Permit application fees submitted? I•B _�Amount S 35 ' Receipt # 6-3/7 e <br /> Reconciles With Real Property Lister Yes No Date: O <br /> a � <br /> If not, explain: <br /> r: <br /> y ) <br /> Applicatio Approved Denied Reason for Denial: ✓ �� <br /> > <br /> Land Use: Date: owl— O3 <br /> 2/18/2003 <br />