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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> Subdivision w/o Survey: $10.00 <br /> and//oar Pre-Application <br /> ,reA pplication Form Subdivision wl Survey: $25.00+$5.0011ot <br /> Owner: I + I I c—ha-o-rL4 cAL,,t- LTL{L <br /> Address: �� 6 /2- yY/- �� 3/a Cc-CLO"rl d4,c 6S) <br /> Phone: 7r'o3-10 9 /C�`J heOr� <br /> iT- <br /> Pft2T o� 63�-15a3-ol $bG OriainalParcel Information / <br /> R rcel Idp J�7N Range 4 3 <br /> Paentification #: : Township section ,2J .; <br /> z <br /> Original Description (or attach copy): 12 LL OF Z4 7— // 6 P <br /> V 1q A a66-a67' a Aid C 77L&I /aid <br /> i AJ <br /> Current Zonin <br /> o g: rCD- 3 Floodplai&: Wetland&: <br /> fN: <br /> Lake/River Classification: <br /> Name of Water Body: P/ A14 ka.Af <br /> 0 <br /> et <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: C�ir� V V Pl <br /> Acres: <br /> (If parcel is to be surveyed,protide preliminary map. See attached for preliminary mquirements.) <br /> / f <br /> Proposed access to public road: Pr Al e- k1AL '0� JU-7 � <br /> Proposed access to public waters to be provided Y/N: JU C7 <br /> N � � / <br /> If yes, describe access: � <br /> J , <br /> �Lllv <br /> ➢ Does parcel meet Zoning Requirements? YesNo N//V r' <br /> N <br /> °o ➢ Does parcel require a Survey? Yes No n <br /> [poa <br /> ➢ Permit applicationfees submitted. Amount $ .(J Receipt # 3 o <br /> r � <br /> Reconciles With Real Property Lister es ' No Date: <br /> n <br /> If not, explain: <br /> 0 <br /> a <br /> H ' . <br /> Application: Approve / Denied Reason for Denial: td_� z-d &v-r/,)I— 6/1--R j <br /> Land Use: Date: c7 cC <br /> 2/18/2003 <br />