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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: $25.00+$5.00/lot <br /> fa <br /> Owner: h&156a <br /> Address: _36q9rL7Z�ba2 L � pQ ON COMPUTER/SCANNED <br /> � -3� Phone: <br /> Original Parcel Information f1 <br /> 7�/�if e <br /> Parcel Identification #: _ ;ectton Township Range <br /> .: <br /> z <br /> 0 <br /> Original Description (or attach copy): <br /> _ O <br /> y Current Zoning: kk Z FloodglMn Y/N: �� Wetland(Y' N: L4�r <br /> Lake/River Classification:(, ezh >S Z Name of Water Body: <br /> New Parcel Information <br /> It <br /> Proposed New Legal Description and Parcel Size: I f ! 03 <br /> Acres: f <br /> (If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: LP,�j fo.f� u <br /> Proposed access to public waters to be provideCIN: L114,, 1- <br /> f p <br /> d <br /> If yes, describe access: <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> N <br /> ➢ Does parcel require a Survey? Yes No c� <br /> ➢ Permit application fees submitted? O Amount$ c' Receipt # 7 N <br /> A <br /> r <br /> st <br /> Reconciles With Real Property Lister Yes No Date: <br /> If not, explain: © o <br /> o <br /> a <br /> Application A r / Denied Reason for Denial: <br /> oe <br /> Land Use: Date: ._ <br /> 2/18/2003 <br />