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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: $50.00/lot <br /> and/or Pre-Application Form or Map Review Form Subdivision w/Survey: 5200.00+S50.00not <br /> G <br /> Owner: Curtis&Jill Meyer Buyer: Kelsey M.Rauchbauer g <br /> VI <br /> Address: 23077 Shuttleworth Road Address: 23077 Shuttleworth Road <br /> Siren,WI 54872 Siren,WI 54872 5- <br /> Phone: (715)6R9-7591 Phone: (7151 689-2593 0 <br /> a <br /> Original Parcel Information ; <br /> Parcel ID#: 07-006-2-38-17-29-4 01-000-011000 Section 29 Township 38N Range 17W <br /> Original Description(or attach copy): Northeast Ouarter of the Southeast Ouarter Except the South 10 <br /> acres,Section 29,Township 38 North,Range 17 West,Burnett County,Wisconsin.11P elsr• <br /> to <br /> L_ <br /> Current Zoning. ' , oodplain YIN: N Wetlands Y/N: N Lake/River Class: N/A <br /> r\ <br /> > Name of Water Body: Shoreland Agreement/SIPS Y/N: <br /> -a. Farmland Preservation Y/N: Managed Forestry Law YIN: <br /> F:' AK <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: South 20 acres of the Northeast Quarter of the Southeast <br /> Quarter,Except for the South 10 acres thereof,Section 29,Township 38 North, Range 17 West,Burnett <br /> ta <br /> County,Wisconsin. Acres: 10 .. <br /> et <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) %.D <br /> Proposed access to public road: Shuttle Worth Road o� <br /> Proposed access to public waters to be provided Y/N: N/A � <br /> If yes, describe access: <br /> Signature of Owner: ,�' /)/) Date: �// Lf/g—,) \ <br /> Signature of Owner:� f/ , P. /1 Date: 9—/5/_ O./ <br /> Does parcel meet Zoning Requirements? Yes No <br /> N > Does parcel require a Survey? Yes No <br /> o ck-A E. Permit application fees submitted? ❑ Amount$ _� (l,-,ZRECEDVEn <br /> FA <br /> IQ <br /> 0 Reconciles with Real Property Lister Yes No Date: 4001,11 SEP 1 7 2021 j_j) <br /> r <br /> o If not,explain: <br /> c Burnett County <br /> Land Services Department <br /> n <br /> 0 <br /> °- Applicatio . Appro d / . d Reason for Denial: <br /> Land Use: �,,,"...-- 9/Z 249 Z/ Date: <br />