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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: $200.00+$50.00/lot <br /> Owner: M iahaeI rLynn 1adVttr1 k <br /> uyer: B <br /> 4// <br /> Address: 7 �1 �a wf,��s t 4 es+ C-fr Address: <br /> pun bury, wi 51$30 cr <br /> yo <br /> Phone: Phone: <br /> Original Parcel Information <br /> Parcel ID#: 15 9 1 7 / 59 7 19 Section if/6 Township 39 Range l 1-1 <br /> O <br /> Original Description(or attach copy): 1_4 c 2A-3 GS01 4# 4-C)t CO 4 <br /> a <br /> eD <br /> n <br /> Current Zoning: Floodplain Y/N: Wetlands Y/N: Lake/River Class: <br /> o Name of Water Body: Shoreland Agreement/SIPS YIN: J'r <br /> .a ��` <br /> a Farmland Preservation Y/N: Managed Forestry Law YIN: <br /> a <br /> New Parcel Information <br /> Ptt <br /> Proposed New Legal Description and Parcel Size: h.0 k- <br /> 3 Q r Lo <br /> th <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) d <br /> n <br /> Proposed access to public road: <br /> Proposed access to public waters to be provided VN: - 1.... . <br /> If yes,describe access: Ks <br /> ` / ;47:4‘ .d <br /> Signature of Owner: Date: Jo 7'2.J z <br /> i <br /> Signature of Owner: -, / Date: 10 x7. a-) <br /> 1160 teoh il 33- �I <br /> ➢ Does parcel meet Zoning Requirements? Yes No G ` 7f/8" <br /> c ➢ Does parcel require a Survey? Yes No 707'fl 7 <br /> aGfZ <br /> Ca > Permit application fees submitted? ❑ Amount$ ��� Receipt# <br /> 0 Reconciles with Real Property Lister Yes No Date: 1,0 <br /> NI <br /> r V <br /> a If not,explain: <br /> a <br /> a. <br /> 7Z <br /> R <br /> a <br /> y. Applicatio pproved / `e eason for Denial: <br /> Land Use: �a�. J/ 7/ ZD Z/ Date: <br />