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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:$100.00+$1s.00/lot <br /> Owner: 5 e-ti '0 /.�o N <br /> Address: Fo 6o X LYz -7 1,5- 9s-7 ^57 t <br /> I�u L k t w i Sy$S 3 Phone: r7 t S_' H 7 Z- 2-215 <br /> Original Parcel Information B <br /> Parcel Identification#: Section 3 to Township 3 8 Range I g c <br /> Original Description(or attach copy): <br /> O <br /> Current Zoning: Floodplain Y/N: `� is S_ Wetlands YM: -e- <br /> Lake/River <br /> Lake/River Classification: C let sS 3 Name of Water Body: �t`i 4�u d <br /> v �. <br /> c� <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: C S k4 0 <br /> t^ <br /> Lo Covi E� <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: Lo }- 7 U i G T t-{ M <br /> d <br /> Proposed access to public waters to be provided Y/N: N D <br /> If yes,describe access: <br /> CN <br /> a <br /> ➢ Does parcel meet Zoning Requirements Yes No Ll <br /> N f1 <br /> ➢ Does parcel require a Survey? Yes No ° <br /> v <br /> 00 C <br /> ➢ Permit application fees submitted? ❑ Amount$ Receipt# <br /> u <br /> ❑ Reconciles With Real Property Lister Yes No Date: C <br /> a <br /> � w <br /> If not,explain: 4� <br /> o ✓l ✓Y <br /> a cal <br /> Vl <br /> Applicat' : Ap r d'/ Denied Reason for Denial: <br /> G C <br /> G O <br /> Land Use: Date: <br /> 2/18/2003 <br />