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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> and/or Pre-Application Form Subdivision w/o Survey: $10.00 <br /> PP Subdivision w/Survey:$100.00+$15.00/lot <br /> Owner: .5a•aIn D l�o v1 <br /> Address: f o 6o X ZSL <br /> I,u L K , w y- 8-S 3 Phone: X715- 1472- 2-215 <br /> Original Parcel Information s <br /> Parcel Identification M Section 3 Township 3 8 Range ( a o <br /> Original Description(or attach copy): <br /> IN PV <br /> F <br /> 0 <br /> Current Zoning: Floodplain YIN: �-e S Wetlands Y/N: S <br /> 9 <br /> Lake/River Classification: C 1 k SS -3 Name of Water Body: Vn s24Nu d C rte-l C <br /> m � <br /> e <br /> w <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: 5 k4 O <br /> I Lo <br /> o vt <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: C T 4 <br /> C <br /> Proposed access to public waters to be provided Y/N: N D A <br /> If yes, describe access: <br /> Vv <br /> cr <br /> ➢ Does parcel meet Zoning Requirements Yes No Ll <br /> N n <br /> ➢ Does parcel require a Survey? Yes No 3 <br /> ao <br /> o <br /> ➢ Permit application fees submitted? 0 Amount$ Receipt# <br /> x <br /> ❑ Reconciles With Real Property Lister Yes No Date: 'Z <br /> C6 <br /> w <br /> If not,explain: w 4� <br /> o ✓1 ✓� <br /> n, W <br /> V <br /> Applicat• Ap r / Denied Reason for Denial: <br /> O p <br /> Q d <br /> Land Use: Date: <br /> 2/18/2003 <br />