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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> Subdivision w/o Survey: $10.00 <br /> and/or Pre-ApplicationForm Subdivision w/Survey: $25.00+$5.00/lot <br /> ffj-C Owner: /� ! �/7Ce1h <br /> Address: S�I� C'LOWy /4�'0/�0 /T <br /> MAC46; T . ZVl 5M3 Phone: ,71 o? 6— Y7'70 <br /> Original Parcel Information <br /> 17_q , / 3 <br /> Parcel Identification #: u9 D1 IDU Section o2 /q Township t QN Range <br /> z <br /> 0 <br /> Original Description (or attach copy): V• 561 ,Q 3/y % <br /> E /V E V. /y 33 w <br /> o Current Zoning: u ZOt✓ Floodplain ' : Wetlands Y(1S� <br /> �• Lake/River Classification! Name of Water Body: <br /> d <br /> 0 <br /> New Parcel Information +(Jt Q U <br /> Proposed New Legal Description and Parcel Size: <br /> y0 � wt � � 6/ <br /> Acres: �7, <br /> (If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: C..�OUAI F(q R o cC Cl 14 <br /> Proposed access to public waters to be providedY& v <br /> M <br /> If yes, describe access: <br /> ➢ Does parcel meet Zoning Requirentfnts? Yes No <br /> o ➢ Does parcel require a Survey? Yes No c <br /> ➢ Permit applicalion fees submitted? 1 Amount $ I U' Receipt # <br /> A <br /> z <br /> ❑ Reconciles With Real Property ster Yes No Date: p <br /> If not, explain: —arlSl2eA f 3 Su <br /> �� iIY�S%�lAY `l`(`S2m\S fS5 Ln�t t — <br /> o � <br /> Applicat' Approved enied Reason for Denial: <br /> Land Use: Date: <br /> 2/18/2003 <br />