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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+$15.00/lot <br /> Owner: GSE STEN Z Ez- <br /> Address: )/ iZ <br /> jr�t�Sor y�l I 5¢o Z-7 Phone: 7/.S e,,c78 3 Z¢lo <br /> A <br /> Original Parcel Information 3 <br /> coo <br /> Parcel Identification #: m�3o-d-¢/3- a5 lection I Township 4,0 Range/ o <br /> Original Description (or attach copy): Zo /' T Zv T --;e ��sT E f3 (.f) <br /> y i<E 1�,9 <br /> 47 <br /> O <br /> / F <br /> y Current Zoning: /2 g I Floodplain Y/N: N//.' Wetlands Y/N: /✓o n <br /> a <br /> g Lake/River Classification: Name of Water Bo <br /> m d y' f0 <br /> e <br /> a. <br /> New Parcel Information <br /> S <br /> Proposed New Legal Description and Parcel Size: �E✓�T/F ic�D e�� �E>/ ���gP (� <br /> Go Ts <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) N <br /> 0 <br /> Proposed access to public road: <br /> � ��., C7 <br /> Proposed access to public waters to be provided Y/N: c <br /> If yes,describe access: <br /> J <br /> ➢ Does parcel meet Zoning Requiremept, ____Yes_ No <br /> ➢ Does parcel require a Survey? Yes No g <br /> e <br /> e <br /> ➢ Permit application fees submitted? ❑ Amount$ L4 S' U C) Receipt# "1 3 29 A <br /> x <br /> ❑ Reconciles With Real Property Lister Yes No Date: U� <br /> a � <br /> If not,explain: <br /> 0 <br /> C <br /> CL <br /> F <br /> 1 <br /> P <br /> Applicatlo �Approvedenied Reason for Denial: <br /> P <br /> /, <br /> Land Use Date: (J <br /> 2/18/2003 <br />