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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> Subdivision w/o Survey: S10.00 <br /> and/or /'1C <br /> Pre-Application <br /> 1V <br /> a�ntionn IForm Subdivision wtSurvey:s100.00+$15.0011ot <br /> Owner: M1lki-ek L . Ai 1 � <br /> Address: S01 W , c0 1,5 0 A 0 r , D M e_M � 1 Y <br /> r L <br /> 6-A-L 5 U.1`q . W 1 , S4 ;F U o Phone: 7/.5- 6 f(9 - 3 a o 0 <br /> b <br /> Ori inal Parcel Information W e51 yrira�s "� 3 <br /> n4o-3ro3 �o1 -Noo � <br /> Parcel Identification#: ON o-3635-o 1 -1vo Section 3 Township 39 N.Range 19 <br /> Original Description(or attach copy): N W �q A.hd N W S W y <br /> O <br /> 0 <br /> > Current Zoning: lel o AC, Floodplain YIN: Al Wetlands Y/N: No <br /> Ma <br /> V 3 <br /> g Lake/River Classification: Name of Water Body: — <br /> m ¢ <br /> w <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: 3 <br /> P <br /> Acres: <br /> (If parcel Is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> v <br /> Proposed access to public waters to be provided Y/N: A <br /> If yes,describe access: <br /> T <br /> Q <br /> Does parcel meet Zoning Requirements? Yes No <br /> A <br /> Does parcel require a Survey? Yes No v <br /> ro w <br /> ➢ Permit application fees submitted? ❑ Amount S Receipt# <br /> at <br /> p O <br /> ❑ Reconciles With Real Property Lister Yes No Date: U s <br /> 0 0 <br /> a W <br /> � If not,explain: w <br /> a <br /> N <br /> 1 1 <br /> Application: Approv / Denied Reason for Denial: J p <br /> d <br /> A ✓ c�� ��� 1G S� e� �� (C�/lw <br /> Land Use• Date: <br /> 2/18/2003 <br />