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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: Kimberly Smiley Buyer: Linda Smiley- Life Estate ►o <br /> Address:8640 State Rd 77 Address: 8616 State Rd 77 B <br /> Danbury WI 54830 Danbury WI 54830 <br /> P <br /> Phone: Phone: $� g tP <br /> N <br /> Original Parcel Information ;` <br /> V <br /> Parcel ID#: 07-032-2-41-17-24-4 04-000-011000&012000 Section 24Townshi 4p 1 N Range 17W V4 <br /> O <br /> Original Description(or attach copy): SE-SE & E 990' SE-SE 4o <br /> co <br /> n <br /> . a <br /> Current Zoning: RR3 Floodplain Y/N: N Wetlands Y/N: Y Lake/River Class: 4 <br /> p Name of Water Body: Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation Y/N:N Managed Forestry Law Y/N:N \3 <br /> New Parcel Information .� <br /> Proposed New Legal Description and Parcel Size: CSM <br /> Acres: <br /> 4- <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: C7 <br /> m <br /> t <br /> Proposed access to public waters to be provided Y/N: `D <br /> If yes,describe access: <br /> Signature of Owner: /)'/)17 .2.11.4.1",„ Date: 5- /" a0 1 <br /> D <br /> Signature of Owner: ��h'�`,� G.- _xi y,, Date: 5-1/ - ai a/ o <br /> C'G <br /> Does parcel meet Zoning Requirements? Yes No `- #6o 1'1 a <br /> co <br /> O > Does parcel require a Survey? Yes No <br /> °Q > Permit application fees submitted? 0 Amount$ 5 2 Receipt# <br /> i. <br /> -4 <br /> m Z Reconciles with Real Property Lister an No Date: b- a.�-�) ,\ 1•3 <br /> = <br /> a. If not,explain: <br /> n N <br /> n <br /> 0 <br /> a <br /> V <br /> Application Approved Denied Reason for Denial: <br /> See. ion- use- h e#AIM ' #Gu '- z/- 298' <br /> Land Use: 9 `- J--r 6 03 20Z/ Date: <br />