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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+$5.00/lot <br /> Ow:tcr: I c7Wni pE <br /> Lo <br /> Address: 157/Af j �1 <br /> 1a3ll �SSEM(3LY I�D ( -,(z/ 5�i one: 4-86 -2t, CSU <br /> Ori final Parcel Information ro <br /> 630 <br /> Parcel Identification CAO�10 az-)_Section�_Township �� Range z <br /> Original Description (or attach copy): <br /> 0 <br /> Current Zoning: Floodplain Y/N: INC) Wetlands Y/N: <br /> ,a ` <br /> Lake/River Classification: Name of Water Body: \ <br /> 0 <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: C <br /> 45EC-7 CSAA V PA —1 I ca, <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> Proposed access to public waters to be provided YIN: <br /> If yes, describe access: <br /> o ➢ Does parcel meet Zoning Requirements? Yes No <br /> ➢ Does parcel require a Survey? Yes `No <br /> ➢ Permit application fees submitted? L� Amount$ Receipt # <br /> c <br /> A <br /> ❑ Reconciles With Real Property Lister Yes No Date: <br /> a <br /> If not,explain: <br /> o � <br /> a _ � <br /> 7 <br /> Application. Approve / Denied Reason for Denial: <br /> Land Use: Date: �✓�' G� C, <br /> 2/18/2003 Cl <br />