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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+$15.00/lot <br /> /lYL / <br /> Owner: U dw <br /> Address: LLid I /b ql h_w7t I(CzC p / <br /> dl, Yl �ir 5y8�Z Phone: 715-866- <br /> A <br /> 7 Orieinal Parcel Information / 3 <br /> Parcel Identification#: 6�8 ✓ �lJ Section 30 Township 39A/ Range <br /> Original Description (or attach copy): AAE /LI 4/1/u X/ <br /> 11 <br /> > Current Zoning: M NZ b PA FloodplainY Wetlands Y L/ <br /> "M <br /> '— Lake/River Classification: — Name of Water Body: <br /> m <br /> e <br /> New Parcel Information L <br /> Proposed New Legal Description and Parcel Size: <br /> Acres: y� <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> d <br /> Proposed access to public waters to be provided)6�- A <br /> If yes,describe access: <br /> ➢ Does parcel meet Zoning Require ts? Yes No <br /> P1 0 <br /> 'e ➢ Does parcel require a Survey? <br /> Ye <br /> No 3 <br /> 00 <br /> °e <br /> ➢ Permit application fees submitted? ❑ Amount$ Receipt# <br /> u <br /> oO <br /> o ❑ Reconciles With Real Property Lister Yes No Date: � <br /> a <br /> I <br /> If not,explain: w wu <br /> na W W <br /> w W � <br /> I <br /> C 0 <br /> Applicatio Approved / enied Reason for Denial: <br /> O <br /> O O <br /> O <br /> Land Use: Date: �—a <br /> 2/18/2003 <br />