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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: $25.00+x5.00/lot <br /> Owner: e e \r CX <br /> Address: 2i lEc 5p,r i+ Lai-c # Roo 1 <br /> _�7rea/erj wr 548'3 -7 Phone: t„s9 -zs7 � <br /> Oriainal Parcel Information 'o <br /> 03ti - isz� � <br /> Parcel Identification #: c 3 ti - s z 4 -o z - 2ca Section .2�i Township 3 Range i 8 <br /> Z <br /> 0 <br /> Original Description (or attach copy): S V, <br /> QJ <br /> Current Zoning: q -y .' Floodplain Y49Wetlands Y(�) <br /> V <br /> Lake/River Classification: Name of Water Body: <br /> m <br /> New Parcel Information <br /> (3 <br /> Proposed New Legal Description and Parcel Size: L o+ i CS rt `C <br /> V. <br /> Acres: 2 .s 7 P) <br /> (if parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: Roc-d <br /> Proposed access to public waters to be provided Y& t7 <br /> d <br /> If yes, describe access: ° <br /> ➢ Does parcel meet Zoning Requirements? Yes No d <br /> N U <br /> ➢ Does parcel require a Survey? Yes 1 No n t <br /> � 3 <br /> ➢ Permit application fees submitted? Amount$ ,C Receipt # <br /> e <br /> n. <br /> r <br /> ❑ Reconciles With Real Property Lister Yes No Date: <br /> a <br /> If not,explain: <br /> o <br /> n. <br /> N -c <br /> Application: A prov / Denied Reason for Denial: <br /> Land Use: /.3' <br /> 2/18/2003 L// <br />