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tyc� nPU�EsraV <br /> Burnett County u 1VISlon er I llcatlon 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: 'iieAQw A Ve/%t, 010536702 3D 1 ( LOT 1) <br /> Address: l`D 9y Cil ld� ���� 0 l$330 d 2 30 2 ( OT Z� <br /> p1 � 330 70 2 30 3 ( r3) <br /> Intl - � UI "*g%o P�I� 33o�DZ 30'(- C14T {- <br /> one: <br /> Original Parcel Information g <br /> Parcel Identification#: - Section Township i k= Range /4AI' <br /> r o <br /> Original Description (or attach copy): 1� f� t :s v, / <br /> O <br /> 0 <br /> Current Zoning: 'G7t c Floodplain "L - Wetlands Y04 <br /> f � <br /> �• Lake/River Classification: Name of Water Body: <br /> 0 <br /> (V <br /> New Parcel Information <br /> � m <br /> Proposed New Legal Description and Parcel Size: <br /> Acres: ✓' <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: Gl 6�4_ L <br /> i v <br /> Proposed access to public waters to be provided V'M <br /> If yes,describe access: O <br /> •i` <br /> ➢ Does parcel meet Zoning Requireme!ts7 Yes No <br /> N <br /> E. ➢ Does parcel require a Survey? Yes No B <br /> QQ p <br /> ➢ Permit application fees submitted? ❑ Amount$ Receipt# <br /> ❑ Reconciles With Real Property Lister Yes No Date: <br /> a <br /> If not,explain: <br /> 0 <br /> a <br /> Applica ' n: Approv -Denied Reason for Denial: <br /> Land Use: Date: S <br /> 2/18/2003 <br />