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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> and/or Pre-Application Form Subdivision w/o Survey: $10.00 <br /> p-/p� Subdivision w/Survey: $25.00+$5.00/lot <br /> Owner: <br /> Address: <br /> �� G1J/ ay�3c PIIone: 6'ez— 3a 14 <br /> Original Parcel Information <br /> 37--'52-26-01 L/ <br /> Parcel Identification #: /� Section / l/, - / 3• <br /> Section. y/N Range /JW <br /> Original Description (or attach copy): u Z, <br /> SLY <br /> O <br /> a Current Zoning: Z Floodplain Y6 Wetlands Y(O <br /> Lake/River Classification: Name of Water Body: <br /> m <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: 51n 1 <br /> �smV. as Palo-ail <br /> -- Acres: AQ,g <br /> (If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: —in n- 616 V--e- <br /> Proposed access to public waters to be provided <br /> d <br /> If yes, describe access: <br /> ➢ Does parcel mect Zoning Requirements? Cles No O <br /> N Q L <br /> �• ➢ Does parcel require a Survey? Yes No n <br /> 0 <br /> 3 <br /> ➢ Permit application fees submitted? Amount $_AS_._QD$_S_._ Receipt # �� <br /> r � <br /> ❑ Reconciles With Real Property Lister Yes No Date: O O <br /> a <br /> If not, explain: <br /> o � � <br /> a 4J <br /> � R3 <br /> t <br /> Application: Approved Denied Reason for Denial: ti��� dY5zk S /1' -la/ d <br /> Land Use: l�/ p <br /> Date: <br /> • J <br /> 2/18/2003 (` <br />