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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br /> Survey of Existing Parcel: $50.00/lot <br /> and/or Pre-Application Form ;_ ,___:__ - i$:01.,00±/lot <br /> IDimpireemmt. U E <br /> v E riOwner: Sena Christopherson Buyer: bAddress: 24225 Range Line Rd Address: iniP,A . - II 2 <br /> W 35(� P <br /> Grantsburg, WI 54840 Fn <br /> Land Services Department C <br /> Phone: 715-689-2375 Phone: LTA <br /> 07-042-2-38-18-12-1 03-000-011000 (Tax ID:28577) Original Parcel Information <br /> 07-042-2-38-18-12-1 04-000-011000 (Tax ID:28578) <br /> Parcel ID#: 07-042-2-38-18-12-1 04-000-012000 (Tax ID:28579) Section 1 2 Township 38 Range 18 <br /> Original Description(or attach copy): SW1/4-NE1/4 4 <br /> ft <br /> SE1/4-NE1/4 Except South 10 Acres <br /> South 10 Acres SE1/4-NE1/4 <br /> Q <br /> oCurrent Zoning: U n z on e d (Sc A2 Floodplain Y/N: Wetlands Y/N: <br /> 2, <br /> Lake/River Classification: Name of Water Body: <br /> Shoreland Agreemt or SIPS Y/N: Farmland Preservation Y/N: Managed Forestry Law Y/N: <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: Proposed CSM <br /> O <br /> Acres: 80± <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: Range Line Road & Hegge Road p <br /> ax <br /> A <br /> Proposed access to public waters to be provided Y/N: <br /> If yes, describe access: <br /> Signature of Owner: . '�\ Alk - Date: (J <br /> Signature of Owner: Date: 0 <br /> N > Does parcel meet Zoning Requirements? Yes No 4,0- -- t177f 1 3�•4Pl2 <br /> =. ➢ Does parcel require a Survey? Yes No <br /> RoD SIC 'X33- Z17.r <br /> Permit application fees submitted? 0 Amount$ 3 c©1- Receipt# <br /> ® Reconciles with Real Property Lister ® No Date:3/a3jaO&.1 `'•0 <br /> goo <br /> a <br /> rifl If not,explain: 6.0 <br /> tl+ <br /> 0 V <br /> a. .°Q <br /> k <br /> Applicatio • • pproved / )enied Reason for Denial: 0\ <br /> Land Use: - 04/07ii Date: <br />