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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 Subdivision w/Survev: $200.00+$50.00/lot <br /> Owner: Smith Lake LLC Buyer: Theodore L. & Thprpsa C. Priem ,,y <br /> A <br /> Address: 1105 Pine S e t- Address: 10915 First Avenue North <br /> St. Croix Falls, WI 54024 Plymouth, z <br /> tvIIV 55441 ° <br /> G^� <br /> Phone: Phone: 952-412-6720 aj <br /> Orieinal Parcel Information Ci_ <br /> w <br /> Parcel ID#: 07-024-2-39-14-02-4 02-000- Section _.L Township 39 Range 14 <br /> 011000 <br /> Original Description(or attach copy): Cot7v of Deed Attached <br /> A <br /> ;1 <br /> o I�Current Zoning: h'3 Floodplain Y/N: N Wetlands Y/N: N Lake/River Class: N <br /> V <br /> m Name of Water Body: None Shoreland Agreement/SIPS Y/N: N <br /> o T <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N: N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: C= of Deed attached <br /> Acres: 2.0 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: Borders County Road A <br /> Proposed access to public waters to be provided Y/N: N <br /> If yes,describe access: nn <br /> Signature of Owner: � ,,. <br /> Signature of Owner: Date: c <br /> e <br /> ➢ Does payee!meet Zoning Requirements? Yes No <br /> ➢ Does parcel require a Survey? Yes No <br /> o' <br /> °Q ➢ Permit application fees submitted? Amount$ Receipt# <br /> reconciles with Real Property Lister Yes No Date: <br /> v <br /> 0 <br /> If not,explain: <br /> 0 <br /> c <br /> y <br /> Application: Approve Denied Reason for Denial: <br /> JUL <br /> Land Use: Dater <br /> ZONING LINTY <br />