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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+$15.00/lot <br /> Owner: DALE E JANL SLGEN <br /> Address: l 14 -I 8 At. S�oe e, D r. o f <br /> Qrd-n+96wt-moo W1 5q 8'40 Phone: ? I5 — toSl4— 9454 <br /> A <br /> Orieinal Parcel Information_ 2 <br /> 042 9100 of too <br /> Parcel Identification#: 047- 92oo of Zoo Section Z-1 Township 38 Range 18 <br /> Original Description(or attach copy): 50s- ATfIK l,+QQ c a1- <br /> > Current Zoning: �a Floodplain YIN: to Wetlands Y/N: Na <br /> �. <br /> Lake/River Classification: 4Pt Name of Water Body: <br /> e f <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: 3 t-"T c5wl <br /> Acres: 3 f4 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: D 1 ¢G CT" <br /> 0 <br /> Proposed access to public waters to be provided Y/N: tjo <br /> If yes,describe access: <br /> J <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> N f] <br /> 0 <br /> o ➢ Does parcel require a Survey? Yes No e <br /> e <br /> ao <br /> ➢ Permit application fees submitted? ❑ Amount$ Receipt# <br /> u <br /> LJReconciles With Real Property Lister Yes No Date: <br /> CL A D <br /> If not,explain: $ <br /> 0 <br /> i <br /> a o 0 <br /> w <br /> P <br /> Applic ton: Approved / Denied Reason for Denial: <br /> Land Use: Date: <br /> 2/18/2003 <br />