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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> and/or Pre-Application Form Subdivision w/o Survey: $10.00 <br /> PP Subdivision w/Survey:$100.00+$15.00/lot <br /> Owner: S )k- l A 4 o L-.S <br /> Address: C�) 2-k-7— <br /> q__% <br /> S_� <br /> q—%S�3 Phone: —1kT -Z, Z-Zi s �J <br /> m <br /> Original Parcel Information ' <br /> m 4-z z 5 3�, o f zoo B <br /> Parcel Identification#: Section {o Township 3Z' Range U o <br /> Original Description (or attach copy): 9J <br /> O <br /> F <br /> o Current Zoning: / Floodplain Y/N: L° 5 Wetlands Y/N: <br /> ;,• Lake/River Classification: CJ Q Name of Water Body: �-)41 Aavi\c¢ � �,(p iQ <br /> d <br /> 0 <br /> X<1 .. <br /> New Parcel Information F�— <br /> O <br /> Proposed New Legal Description and Parcel Size: <br /> L—OT S AG s k AJ4%r <br /> .� <br /> Acres: <br /> r <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: L!QT% \' &2 Mkt, S �IOQY L,K RD <br /> � � o7S '3 t^4 vim 5. SilUw 1-uEp d <br /> Proposed access to public waters to be provided Y/N: O I" <br /> If yes,describe access: -Z <br /> 11 <br /> Vv <br /> 1 <br /> O <br /> ➢ Doev parcel meet Zoning Requirements? Yes No c� <br /> N n <br /> °o ➢ Does parcel require a Survey? Yes No ° <br /> o vao <br /> ➢ Permit application fees submitted? ❑ Amount$ Receipt# <br /> x <br /> r o0 <br /> Reconciles With Real Property Lister _ Yes No Date: z <br /> C6 <br /> oIf not,explain: O <br /> w� <br /> 6 0 <br /> Application: Approved / Denied Reason for Denial: <br /> 0 <br /> CCJC <br /> Land Use: Date: <br /> 2/18/2003 <br />