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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+$50.00/lot <br /> Owner: Douglas Buerke Buyer: Peter Buerke <br /> b <br /> eD <br /> Address:28812 Kilkare Green Way Address: 13835 214th Ave NW B <br /> Danbury WI 54830 Elk River MN 55330 <br /> : <br /> CZ <br /> Phone: Phone: 218-576-6901 C <br /> Original Parcel Information <br /> 07-012-2-40-15-12-5 15-400-049000,050000,051000 v <br /> Parcel ID#: Section 12 Township 40N Range 15W <br /> Original Description(or attach copy): Kilkare Green Add to Voyager Village Lots 39-41 4 <br /> R <br /> bCurrent Zoning: PUD Floodplain Y/N: Y Wetlands Y/N: N Lake/River Class: <br /> a Name of Water Body: N/A• Shoreland Agreement/SIPS Y/N: 1~ Cvl <br /> Farmland Preservation Y/N:N Managed Forestry Law Y/N:N <br /> New Parcel Information (b k <br /> Proposed New Legal Description and Parcel Size: CSM 3 lots into 2 lots <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: t7 <br /> a <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: W\ <br /> Signature of Owner: Da 54 Date: 03/10/2021 N <br /> LG <br /> Signature of Owner: /6i1, 5a4446 Date: 03/10/2021 c <br /> B <br /> .a <br /> > Does parcel meet Zoning Requirements? Yes No .# �O' <br /> N 's <br /> > Does parcel require a Survey? Yes No <br /> aro �1 O <br /> Permit application fees submitted? ❑ Amount$ /00z Receipt# J <br /> r., ❑Reconciles with Real Property Lister Yes No Date: <br /> a <br /> a 1 <br /> o ,.1 <br /> a. If not,explain: .4 <br /> ft <br /> 0 �y <br /> o 0 <br /> 0. <br /> VI <br /> 1 <br /> ApplicationApprove enied Reason for Denial: <br /> — <br /> Land Use: 7 /3 Z Date: <br /> / <br />