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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> Subdivision w/o Survey: S10.00 <br /> and/or Pre-Application Form Subdivision w/Survey: $25.00+$5.00/lot <br /> Owner: V EkA PE' L0 Q U 1*1V <br /> Address: 5e Y/ / 6- /c-e-e.GC. /1 Cr�ic U/`p <br /> a-lZ421�1�/Zj 101 sj�VS(7, Phone: <br /> Original Parcel Information <br /> iia-9aso-of-aoo - '�`/ <br /> Parcel Identification#: -:�on— S/Ov SectioJO 3' Township Range <br /> z <br /> Original Description (or attach copy): L��t(t I . 7 , �� l� I a F Z4 <br /> PLA t or 0"*%4 W1410ti <br /> 0 <br /> 9 Current Zoning: R I Floodplain YG Wetlands Y& <br /> �• Lake/River Classification: Name of Water Body: <br /> m <br /> 0 <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: 2 `O? C S n'I <br /> C'_srn V Iq <br /> Acres: l00 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> (� <br /> Proposed access to public road: gu'a/-� /ty2/ ✓�-� <br /> Proposed access to public waters to be provided Y19 <br /> A <br /> If yes,describe access: <br /> v <br /> RJ <br /> ➢ Does parcel meet Zoning Requirements? Yes No c�• <br /> N <br /> ➢ Does parcel require a Survey? Yes No n <br /> L/ 3 <br /> ➢ Permit application fees submitted? Amount$ U✓ Receipt# T ��3 <br /> A <br /> a <br /> Reconciles With Real Property ListerYes No Date: <br /> a C' <br /> oIf not,explain: <br /> a � <br /> Applicatio . ved / Denied Reason for Denial: 1 <br /> C <br /> r� 1 <br /> Land Use: Date: o y3 <br /> 2/18/2003 <br /> (Ciiis2 pu (ecei*,' c oPy 9 3 Q3 <br />