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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> Subdivision Vo Survey: $10.00 <br /> and/or Pre-Application Form Subdivision W/Survey: $25.00+$5.00not <br /> Owner: n <br /> Address: -z _��7� LoNc Ptrl e7 12�D <br /> Phone: <br /> Original Parcel Information ;? <br /> Parcel Identification#: 020 4320 OZ 2 r� Range/46 <br /> / ` 3 <br /> / �� Section�_Township � Range/y z <br /> 0 <br /> Original Description (or attach copy): Gokj, C.o`r' Z. EX copt T <br /> A"b CstA y, 1S 42 , / 96 <br /> 1 o <br /> Current Zoning: R f Floodplain Y/N: Np Wetlands Y/N: n <br /> Lake/River Classification: Name of Water Body: <br /> ( ALL ot.J AIC�' <br /> I9 ppq-/8dewParcel Information <br /> Proposed New Legal Description and Parcel Size: <br /> Lot oQ Yelfoj LAle-0 - 'Fxrs-�tti� LGSe,"t <br /> 1.13 Acves Cusf �A_Lb" c> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> Proposed access to public waters to be provided Y/N: o <br /> w <br /> If yes, describe access: <br /> Does parcel meet Zoning Requirements? es No <br /> N <br /> a ➢ Does parcel require a Survey? Ye No e <br /> uo �( 403q <br /> 3 <br /> ➢ Permit application fees submitted? Amount$ 3(]"�� Receipt # <br /> ,Y A <br /> a <br /> oReconciles With Real Property Lister es No Date: <br /> Q. <br /> If not,explain: <br /> o. <br /> _.... <br /> 1 <br /> Applicatio : Approved enied Reason for Denial: C� <br /> p � <br /> Land Use: Date: <br /> 2/18/2003 <br />