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ON COMPUTER/SCANNED <br /> Burnett County Subdivision Permit Application Fees(must accompany form); <br /> and/or Pre-Application Form Subdivision w/o Survey: $10.00 <br /> 1�13 Subdivision w/Survey:$100.00+$15.00/lot <br /> Owner: <br /> Address: 24-c 3 7- <br /> Cdu.,.ry 7�o.aa X <br /> ter Phone: i,>r— �68 ¢0 68 <br /> Original Parcel Information 3 <br /> Parcel Identification #: of—Soo Section 13 Township 39 Range LS— c <br /> Original Description(or attach copy): S Viz, oG S�/ /E c—x�wT <br /> UE�yG2�TSE� iN DcED ✓m` 34-� �,.�E 4� <br /> 0 <br /> > Current Zoning: A/•-JE Floodplain Y& Wetlands Y& <br /> Lake/River Classification: Q. Name of Water Body: __Al <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: '41 P er-- <br /> -z • S34— <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) 3 <br /> Proposed access to public road: A 3 r5 Ga u.v ry ?Z r� i1' <br /> d <br /> Proposed access to public waters to be provided YID <br /> If yes,describe access: <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> S. ➢ Does parcel require a Survey? Yes vo � g° <br /> 00 <br /> ➢ Permit application fees submitted? O Amount$ Receipt # <br /> e O Reconciles With Real Property Lister Yes No Date: <br /> a <br /> If not, explain: Su <br /> a <br /> O <br /> Application: Approved / Denied Reason for Denial: <br /> O <br /> .1 a <br /> o C7 <br /> Land Use: Date: <br /> 2/18/2003 <br />