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ON COMPUTER/SCANNED <br /> 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 /> I Ili <br /> Owner: _ #Y`I C UeQi7Y L <br /> Address: i� (.LJ � K e7— <br /> xb& �Y:I 44, MI _'5 1c2J Phone: �a " / /- <br /> b <br /> ,,}} `/ �/Original <br /> Parcel Information 1 <br /> Parcel Identification #: tJ -1 � —A74ection� L Township 7D/V Range <br /> 0 <br /> / 33 <br /> (� <br /> Original Description (or attach copy): L, 3 — .� 3� <br /> O <br /> pvc � <br /> y Current Zoning: k Floodplain Y/N: Wetlands Yo�[- - :! <br /> Lake/River Classification: Name of Water Body: 6,efulm L � <br /> m <br /> o <br /> New Parcel Information `l <br /> Proposed New Legal Description and Parcel Size: <br /> Acres: 63 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> 114-Proposed access to public road: A0— 'Cl �e . <br /> O <br /> Proposed access to public waters to be provided <br /> If yes,describe access: <br /> 0 <br /> ➢ Does parcel meet Zoning Requirements? es No <br /> N n <br /> ➢ Does parcel require a Survey? Yes No ° <br /> B <br /> n <br /> ➢ Permit application fees submitted? O Amount& b,Uu Receipt <br /> r Q <br /> Reconciles With Real Property Lister Yes No Date: <br /> El <br /> a <br /> If not,explain: <br /> o n\ <br /> a <br /> y /,a <br /> Applicatio . Approved / Denied Reason for Denial: <br /> i <br /> Land Use: Date: <br /> 2/18/2003 <br />