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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> and/or Pre-A lication Form Subdivision w/o Survey: $10.00 <br /> PP Subdivision w/Survey: $25.00+$5.00/lot <br /> Owner: Niles K. and Marjorie Peterson <br /> Address: 23789 Peterson Road <br /> Siren, WI 54872 Phone: 715/349-2844 <br /> Oritinal Parcel Information <br /> Parcel Identification#: 006-2413-03 200 Section 13Township 38N Range 17W 3 <br /> -• <br /> z <br /> Original Description or attach co The SWC SES ° <br /> g� p ( copy): , „ Section 13-38-17 <br /> so <br /> v Current Zoning: A-2 Floodplain Y/N: NO Wetlands Y/N: NO <br /> A <br /> n <br /> Lake/River Classification: Name of Water Body: , <br /> 7 <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: The South 720 feet of the SW; SE;, <br /> Section <br /> nr o QQ 1 7 wPgt• PXnPi 1-i ng f-hP Cniirh <br /> 390 feet thereof. 10 <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: Peterson Road <br /> Proposed access to public waters to be provided Y/N: NO / <br /> � m <br /> If yes,describe access: '; / ••� <br /> ➢ Does parcel meet Zoning Requirements? Yes o <br /> N N1oNINGU/V7Y h <br /> °o ➢ Does parcel require a Survey? Yes No <br /> � o <br /> ➢ Permit application fees submitted? ❑ Amount$ Receipt# <br /> A <br /> ❑ Reconciles With Real Property List Yes No Date: <br /> If not,explain: <br /> o <br /> a <br /> Application: Approved / enied Reason for Denial: w <br /> O <br /> Land Use: Date: :5 c/ <br /> 2/18/2003 <br />