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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> and/or Pre-Application Form Subdivision w/o Survey: s10.00 <br /> n INam-�- Subdivision w/Survey:S 100.00+S 15.0011ot <br /> Owner: I�C(� �a / 0011 (a- k h lt— <br /> Address: t U l�li <br /> 3 C.' Phone: <br /> Z()00 Original Parcel Information �/ '/ 3 <br /> Parcel Identification #: 626-qlo l - aZ� Section 26 Township /7�e/V mange /6 o <br /> Original Description p(or attach copy):�p yL6T 15-/(o D F 1 16 C /- "yt U3 <br /> n�_ <br /> O <br /> Current Zoning: - Floodplain Wetlands Y V/ : <br /> Lake/River Classification: Name of Water Body: �— � <br /> m c? <br /> R <br /> New Parcel Information <br /> t <br /> Proposed New Legal Description and Parcel Size: R��V i 5-IC>-u <br /> 0 <br /> Acres: 391 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: C.7 {�_ V r <br /> — L� C>l a„ � ckiy.,e.J <br /> Proposed access to public waters to be provided <br /> If yes,describe access: <br /> ➢ Does parcel meet Zoning RequirementsV Yes No <br /> ➢ Does parcel require a Survey? YesA <br /> No 9 <br /> ➢ Permit application fees submitted? O Amount S <br /> Receipt# A <br /> °° ❑ Reconciles With Real Property Lister Yes o <br /> a No Date: a� <br /> R If not,explain: <br /> 0 <br /> Applicata Approved Denied Reason for Denial: ;SG2 �u IOGQck rs/Jn. `f '9t7i'G a p <br /> YY ac <br /> �C) oQw -� oti e �,74— <br /> Land Use• <br /> Date: <br /> 2/18/2003 <br />