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ON COMPUTER/SCANNEQ <br /> Burnett County Subdivision Permit Application Fees(must accompany form): <br /> and/or Pre-Application Form Subdivision w/o Survey: $10.00 Subdivision w/Survey:S 100.00+$15.00/lot <br /> Owner: 1'Qi <br /> Address: <br /> 1 Phone: q3IN <br /> -o <br /> Ori final Parcel Information 19 <br /> � <br /> Parcel Identification#: 07:Q -V17'3 /5� Section L Township G/1� Range IqK/ c <br /> Original Description (or attach copy): 5E/y 5 t <br /> O <br /> Current Zoning: Ptzo Floodplain Wetlands <br /> Lake/River Classification: `- Name of Water Body: ,U-yt� <br /> m <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: <br /> Acres: 12—. /"7 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> v <br /> Proposed access to public waters to be provided YIN <br /> If yes,describe access: <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> N n <br /> � ➢ Does parcel require a Survey? Yes No ° <br /> oa � <br /> ➢ Permit application fees submitted? O Amount S Receipt# <br /> r na <br /> Reconciles With Real Property Lister Yes No Date: <br /> El Reconciles <br /> a <br /> If not,explain: r <br /> CL <br /> _ _P <br /> Application:ppr eov d / Denied Reason for Denial: Ui <br /> G � <br /> Land Use: Date: �` /— d 5 <br /> 2/18/2003 <br />