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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: MAO L4 C_4E t< <br /> Address: Z8(4o QR yN'4brV K v <br /> D4A1?c./Cti WtS ,s48Js Phone: <br /> Original Parcel Information L' <br /> A <br /> 2U-9900- <br /> 160 JL <br /> Parcel Identification #: oz.Zou Section 23 Township�_ Range z <br /> Original Description (or attach copy): - L.p / Z d /3 To L Uhdc,# Aco r j <br /> got d s'l;�f6j,- e� La I 12 Via J <br /> � w <br /> p o <br /> 9 Current Zoping: I� Floodplain(ON: Wetlands&N: <br /> Lake/River\diAlft"c56n' : Name of Water Body: ZA ox, <br /> w � <br /> e <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: Ale.u,,, Cx^ n <br /> 2a f I'�c•r4 L.F I.T f� t!•F !2 � �r/�f'/J/ Ir <br /> Acres: 9 i7 G <br /> (if parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: .S A."K <br /> Proposed access to public waters to be provided OIN: L4o,, <br /> d <br /> A <br /> If yes, describe access: <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> N <br /> ➢ Does parcel require a Surrey? }'es No c <br /> � 3 <br /> ➢ Permit application fees submitted? 0 Amount S Receipt # °e <br /> R <br /> A <br /> 1 <br /> ❑ Reconciles With Real Property Lister Yes No Date: 0 0 <br /> CL <br /> If not, explain: Q <br /> o O <br /> Or <br /> O <br /> Application: pproved / enied Reason for Denial: o 0 <br /> 0 ° <br /> Land Use: Date: <br /> 2/18/2003 <br />