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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:$100.00+$15.00Aot <br /> Owner: HEcs�J NAVKLArJn <br /> Address: HAcitytj_bA, D n— <br /> Su n/ C i r j A-- S S 3 S ) Phone: <br /> A <br /> Orieinal Parcel Information <br /> Parcel Identification#: 4-L-257_6" 03100 Section Zs Township 38 Range a o' <br /> Original Description (or attach copy): FAncC� 1 0 G L CP ren <br /> Y Current Zoning: /Z,e-4 Floodplain Y/N: N Wetlands Y/N: Al <br /> 9V <br /> • Lake/River Classification: / Name of Water Body: Lir�Gc— lv�0 e,,Vlt ✓ <br /> m <br /> e <br /> r <br /> New Parcel Information n <br /> Proposed New Legal Description and Parcel Size: / Com <-SM 3 <br /> / 5- /mi c-xlfrl A/6 Nc-w c or <br /> tr <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) SL <br /> Proposed access to public road: ErXiSri-16 <br /> d <br /> Proposed access to public waters to be provided Y/N: r✓ 4 g <br /> If yes,describe access: L <br /> int <br /> a <br /> ➢ Does parcel meet Zoning Requirements Yes No <br /> N o <br /> °e ➢ Does parcel require a Survey? Yes No 2 <br /> Cw w <br /> ➢ Permit application fees submitted? ❑ Amount$ Receipt# <br /> u <br /> ❑ Reconciles With Real Property Lister Yes No Date: -C <br /> C6 <br /> If not,explain: <br /> o � <br /> iaa �x <br /> U)� <br /> / I <br /> Applici do Approved Denied Reason for Denial: ,Ft 1 Ali <br /> Land Use: Date: <br /> 2/18/2003 <br />