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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+$5.00/lot <br /> Owner: ry,11VIa tD (a 1 C olvyl_ S ka(`av&e <br /> Address: -CG� <br /> S � QC <br /> c`levl G J11 Phone: <br /> Original Parcel Information <br /> / 00 <br /> Parcel Identification#: �O�i-o)t/a/� t)� / Section OL-'<D Township Range <br /> Original Description (or attach copy): SIN 5 l j <br /> Y Current Zoning: 6)42=52%U_ Floodplain Y�Nt Wetlands Y <br /> "v v �D <br /> d <br /> Lake/River Classification: Name of Water Body: <br /> 0 <br /> New Parcel Information <br /> Proposed New. Legal Description and Parcel Size: _ lvkl-u <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: CA,9ee4 4240 <br /> Proposed access to public waters to be provided YO <br /> If yes,describe access: <br /> ➢ Does parcel meet Zoning Requirements? =Yes No Q <br /> N <br /> Q, ➢ Does parcel require a Survey? Yes No 0 <br /> ➢ Permit application fees submitted. Amount$ Receipt # ZY9,L � <br /> ro <br /> r ?� <br /> n Reconciles With Real Property Liste € es No Date: C 2a q <br /> X Qs <br /> If not, explain: s <br /> o <br /> a <br /> N a , <br /> Applicatio . Approved / nied Reason for Denial: <br /> L <br /> Land Use: Date: /g-a - y 3 �� <br /> 2/18/2003 �Ql a 63 `'� <br />