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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+$5.00/lot <br /> Owner: - Pl�l7y <br /> Address: t� 6 Z 2 6 8/e C-,V.AI.7,1 A.`_t-t A'� <br /> V"c �Jf�� w�3 S'4ti43 Phone: ��t;• ry�dS <br /> Orieinal Parcel Information '9 <br /> Parcel Identification#: 6 3 4ae Section Z Township �� Range/6 z <br /> Original Description or attach co t� ���� t f SE %4 Ski�4t <br /> l; P copy): �I E �V �I 9J <br /> Q <br /> v <br /> 0 <br /> y Current Zoning: VP Floodplain Y& Wetlands: <br /> Lake/River Classification: Name of Water Body: <br /> y <br /> New Parcel Information I ` <br /> Proposed New Legal Description and Parcel Size: �-" f C� V � /q <br /> 2 -.�/�� L. f, �'VZ - Imo' % 001 <br /> Acres: J V <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> Proposed access to public waters to be provided Y& v <br /> A <br /> If yes,describe access: <br /> ➢ Does parcel meet Zoning Requirements? Yes No W <br /> N <br /> °o ➢ Does parcel require a Survey? Yes No 0 <br /> g <br /> ➢ Permit application fees submitted? Amount$�� Receipt <br /> A <br /> Reconciles With Real Property ListerYes No Date: a <br /> a r oc <br /> If not, explain: �� �� <br /> H 1 <br /> Applicatio : Appro�/ Deed Reason for Denial: <OWIACO <br /> l" <br /> 0 <br /> Land Use: Date: <br /> 2/18/2003 <br />