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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+$15.00not <br /> VAwo e, K�zay <br /> S"EPFIzEY tc HTH,A 0^i�O K14& <br /> Owner: C2Pi6 RTt+RyN 15_Ht 2WooD <br /> Address: c/o z454-7 GAIT C- 1 lai NT 1zi> <br /> V/EBT—L-.tz- PI S4e,93 Phone: 349 - 7_37o <br /> m <br /> 0 14 zzo z} o-1 -1 1 o Orleinal Parcel Information 'g <br /> 01 + 2204 0`1 -too <br /> Parcel Identification#: 014 zzo 4 o 1 8&ySection + Township 38 Range HS o <br /> Original Description(or attach copy): LOT- 4 r--.M Voi 8 1 P z19 <br /> DO <br /> Laj 5 GSM Yc-t £s Pz1S -- <br /> O <br /> Current Zoning: fY-P-( Floodplain Y/N: tJ Wetlands Y/N: y <br /> 9• Lake/River Classification: Name of Water Body: 1�d AtZni uja_ S <br /> m <br /> 44 <br /> New Parcel Information <br /> S <br /> Proposed New Legal Description and Parcel Size: LC'T S `{- <br /> R� <br /> !tj T-Z) 3 NCV✓ LOT_S <br /> Acres' 6,4- t' o cA <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: $y L A's C-AnL-NT <br /> t7 <br /> Proposed access to public waters to be provided Y/N: N g <br /> If yes,describe access: <br /> dO <br /> ➢ Does parcel meet Zoning Requirements? Yes ! No V <br /> N �l <br /> ➢ Does parcel require a Survey? Yes ) No °g <br /> e e <br /> � e <br /> ➢ Permit application fees submitted? ❑ Amount$ Receipt# <br /> u <br /> r 0 0 <br /> e ❑ Reconciles With Real Property Lister Yes No Date: <br /> C6 <br /> oIf not,explain: o v q <br /> c � <br /> w � �G <br /> J, <br /> Applicatio . Approved Denied Reason for Denial: <br /> C>- <br /> Land Use: Date: �0 2S uS <br /> 2/18/2003 <br />