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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> Subdivision w/o Survey: 310.00 <br /> and/or Pre-Application Form Subdivision w/Survey: $25.00+$5.00not <br /> Owner: yor rzuNNI1 Ij& <br /> Address: 538(o LJC5T 134- ST <br /> SP'vP, Gtr M\J S5378 Phone: _ 5�Sz <br /> Original Parcel Information <br /> 07_o436Zo 35Oo 3 <br /> Parcel Identification#: o z o4-3o z o +4m Section Z Township Range <br /> 0 <br /> Original Description (or attach copy): ATrRc H CD <br /> W <br /> O <br /> > Current Zoning: Floodplain Y/N: Ale, Wetlands Y/N: A16 <br /> V <br /> Lake/River Classification: 3 Name of Water Body: LooAJ <br /> m � <br /> e p <br /> S <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: CatzT-i F1 c-> Su r2V c,r M AT <br /> 0 <br /> 6'F C—?e i ST-)ry G PA>zeEt-S til e NEEW PArzeCL5 C rz(n-rcD , <br /> 1- <br /> Acres' ( ,31 3 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) j <br /> J <br /> Proposed access to public road: do T-1,1N rl iZO A V, <br /> Proposed access to public waters to be provided Y/N: yiGs v <br /> If yes,describe access: j_c T 1 1 S o ri Loan/ c7Ze7ty iG <br /> > Does parcel meet Zoning Requirement 2Yes No W <br /> N <br /> > > Does parcel require a Survey? Yes No e <br /> v°o 3 <br /> > Permit application fees submitted? ❑ Amount,S Receipt# <br /> A <br /> x <br /> c ❑ Reconciles With Real Property Lister Yes No Date: W Ai <br /> � 0 0 <br /> g If not,explain: <br /> o <br /> Application: App�ro <br /> vye Denied Reason for Denial' <br /> Land Use: Date: // �� � 1ai00/�f <br /> 2/18/2003 <br />