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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: S50.00 <br /> Survey of Existing Parcel: $50.00/lot <br /> and/or Pre-Application Form Subdivision w/Survey: S200.O0+550.00/lot <br /> Owner: Voyager Village POA Buyer: <br /> *a. <br /> Address.28851 Kilkare Rd Address: . s <br /> Danbury WI 54830 0 <br /> . <br /> C <br /> Phone: Phone: OD <br /> Orkinal Parcel Information <br /> Pareei ID#1 G7'4138-24144.31--5 IS-105-131M0014 020000 foh l Township 4I N Range 14W gil <br /> Original Description(or attach copy): Crystal Valley Add to Voyager Village Lot 9 & 10 4 <br /> 11)Q <br /> at <br /> b Current Zoning: PUD Floodplain YIN: N Wetlands Y/N: N Lake/River Class: 1/74la _ <br /> m Name of Water Body: N Shoreland Agreement/SIPS Y/N; <br /> T Farmland Preservation Y/N:N .Managed Forestry Law Y/N;N <br /> New Parcel Information. <br /> Proposed New Legal Description and Parcel Size: CSM to combine 2 lots <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: C <br /> 1 toK <br /> ;o <br /> Proposed access to public waters to be provided Y/N: <br /> If <br /> yes,describe access: 0) <br /> Signature of Owner: . 1M1 ' — OF V G yt er liturgy Date: 4- 09 -if <br /> Signature of Owner:. Date: o <br /> a <br /> c <br /> > Does parcel meet Zoning Requirements? Yes No <br /> 4k <br /> N <br /> > Does parcel require a Survey? Yes No <br /> z <br /> QO > Permit application fees submitted? 0 Amount S Receip L ..! <br /> -.l <br /> r El Reconciles with Real Property Lister Yes No Date: _ . W `t <br /> ` <br /> If not,explain: t � � �.I J <br /> IS—co. Cii <br /> o N ...'%; <br /> Application: Approved / Denied Reason for Denial: <br /> Land Use: Date: <br />