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Burnett County Subdivision Permit Application <br /> Fees(must accompany form): <br /> and/or Pre-Application Form or Map Review Form Subdivision v4 o Surrey: .$50.01 <br /> Survey of Existing Parcel: $50.00 lot <br /> Suhdir i,ion v, Sunev: 5200.00 SCO 00 lot <br /> Daniel Cheimo " <br /> Owner: Buyer: b <br /> kddress: X '397 <br /> Address: <br /> , . ,)MA WI 54982 <br /> Phone: Phone: <br /> Original Parcel Information <br /> Parcel ID#: 07-020-2-40-16-33-5 05-004-013002 section 33 Township 40 Range 16 <br /> Original Description Inc attach cop.): GL4 EX: N 40 RDS. CSMS VI P261 V24 <br /> P1 r & V24 P270 & CSM Na 5082, v.28. p.196-198 d <br /> 51 <br /> Current Zoning: RR-.l Floodplain YIN: N Wetlands Y/N: N Lake/River Class: N/A. <br /> Name of Water Body: Devils Lake Shoreland Agreement/SIPS Y/N; N <br /> s Farmland Preservation Y//N: Managed Forestry Law YIN: <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Sin: <br /> in Gov. Lot 4. <br /> Acres: 7.26 A <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access <br /> 66" private ease 4 A <br /> Pro <br /> p c s to public road: <br /> Proposed access to public waters to be provided V/N: Ntit <br /> \� <br /> If yes,describe access: <br /> Signature of Owner: Date: 67-u„• 2.c, 2-1 <br /> signature of tiwner: nate: <br /> C <br /> r Does parcel meet Zoning Requirements? Y r No GI # ae/1 co <br /> Does parcel require a Survey? Yes No W <br /> 04 t14 <br /> ➢ Permit application fees submitted? 0 Amount$ ©�t — Receipt.4 <br /> 741 <br /> 0 Reconciles with Real Property Lister Yes No Date: <br /> If not,explain: <br /> a <br /> rt <br /> Application: pproved / i Reason for Denial: <br /> Land Use: -7 zs. vacate: <br />