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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+$5.0011ot <br /> Owner: j6i'eAl ( Jai lYa✓U�t2GC h <br /> Address: 1)-7-36 <br /> _ 6�A Phone: <br /> Original Parcel Information I <br /> 0o4-3163-61- �} , / /y <br /> Parcel Identification #: Section d Township �/19/V Range <br /> . / z <br /> Original Description (or attach copy): 5W VY N W �y <br /> r� <br /> IN <br /> Go <br /> O <br /> Y Current Zoning: )U3 Floodplai&: Wetlands(9 N: <br /> �• Lake/River Classification: C .3 Name of 'Vater Body: ?� GU let t/-&-L) <br /> a <br /> New Parcel Information , <br /> Proposed New Legal Description and Parcel Size: � � 4' 9 P 3 <br /> Acres: 3/. 2-y <br /> �v <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requiremen(s.) C— <br /> Proposed access to public road: <br /> Proposed access to public waters to be provide Y 1'0 ✓ o <br /> I <br /> If yes, describe access: DEC r ti <br /> ➢ Does parcel meet Zoning Requirements? Yes No ZONING O <br /> N �^ <br /> ➢ Does parcel require a Surtsey? Yes No c 1kr <br /> � B <br /> ➢ Permit application fees submitted? Amount $ Receipt # <br /> c <br /> u <br /> Reconciles With Real Property Listeres ' No Date: QIN <br /> a <br /> If not, explain: � <br /> c. <br /> N Q <br /> APP t licatioA )roved Denied Reason for Denial: <br /> PI <br /> ,tom <br /> Land Use: Date: �/ c Z <br /> 2/18/2003 O }� <br /> � W <br />