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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+$5.00/lot <br /> Owner: Tose Pff fW i 1_.e6LL41)EO l—ftD C_Um)O1ji,1 y <br /> Address: I&I ) 1-3 '�_ A vie, L9b <br /> P U. X 9 C1 <br /> 69-U" (_6 N/ Pi 1 �2 Phone: 7115— 753-7- .3` qb <br /> a-3-7-/g- 3z o O zy0o Original Parcel Information ro <br /> a'37 32 D G 'L700 a-37_ig_ 32-d 0300a / <br /> Parcel Identification #: Section 3c)— Township 37A / Range /'9 <br /> z <br /> Original Description (or attach copy): /VW t/ ._ 5 E)y"� NE�y <br /> 5W°ly 5C_ 5F jy 5 E jy <br /> w <br /> 0 <br /> Current Zoning: �- Floodplai&: Wetland&N: <br /> �• Lake/[fiver Classification: Name of Water Body: <br /> T <br /> y� <br /> l� <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: e�'rn <br /> 1& /_ �)Cir 5IL (J'/-J�/m 5� X13 167 — <br /> 3 g4D/Iti 61 <br /> dA Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: k. C�f id, 5ey`-�j,L�dt.J6— 2�� <br /> Proposed access to public waters to be provided V t&)tL C <br /> m <br /> If yes, describe access: <br /> t <br /> s <br /> ➢ Does parcel meet Zoning Requirements? Yes NoQ <br /> ➢ Does parcel require a Surrey? < Yes No n <br /> o <br /> Qo 3 <br /> ➢ Permit application fees submitted? Amount$ 1q6_-LTO Receipt # <br /> ° <br /> m <br /> r � <br /> ❑ Reconciles With Real Property Lister Yes No Date: K�,t 6 w <br /> A <br /> If not, explain: <br /> W W <br /> U•1 Sc) 9J <br /> O Oo <br /> Applicatio Approved )/ Denied Reason for Denial: o <br /> Land Use: Date: <br /> v <br /> 2/18/2003 <br />