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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/Survey: $200.00+$50.00/lot <br /> Owner: Harold &Jennifer Christensen Buyer: ity <br /> Address: PO BOX 400 Address: 4. <br /> Palmyra WI 53156 <br /> kllPhone: Phone: VD <br /> Original Parcel Information <br /> Parcel m#: 07-028-2-40-14-07-5 15-853-032000 Section 07 Townshi 40 Range 14W <br /> 0 <br /> Original Description(or attach copy): Wood Green Addition to Voyager Village Lot 22 4 <br /> S <br /> 1:1 Current Zoning: PUO Floodplain Y/N: N Wetlands Y/N: N Lake/River Class: A_ <br /> t <br /> • <br /> to Name of Water Body: N/A Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N:N <br /> 4. <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: CSM 'P <br /> �• <br /> Acres:0.78 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: t7 <br /> V <br /> Proposed access to public waters to be provided Y/N: "*)\ <br /> If yes,describe access: <br /> Signature of Owner: 7Q4-49 i Date: 171/2-7/2-/ • <br /> • <br /> Signature of Owner: Date: i//�/2i o <br /> a <br /> b <br /> > Does parcel meet Zoning Requirements? Yes No ek Et- 3 78' F <br /> N 4t <br /> a > Does parcel require a Survey? Yes No _ <br /> O <br /> °q > Permit application fees submitted? 0 Amount$ 100 •i� Receipt# Uk <br /> 0 <br /> 11 <br /> d ®Reconciles with Real Property Lister No Date: 5/3/ "�,► <br /> a. If not,explain: U <br /> e CP <br /> et0 <br /> o. � <br /> v <br /> Applicati Approved / D'enied Reason for Denial: d <br /> Land Use: .S- /z'!'21 Date: <br /> Ste. akpU9�9�On aZldu7 ck c — • Vol ria0Ce. ,S6S <br />