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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: $200.00+550.00/lot <br /> Owner: Sidney Sherstad-Siren Telephone Buyer: <br /> PO Box 426 <br /> iAddress: Address: <br /> i <br /> Siren WI 54872 0 <br /> •C <br /> I <br /> Phone: Phone: C <br /> Original Parcel Information KI <br /> r j <br /> Parcel ID#: 07-012-2-40-15-35-5 Section 35 Township 40N Range 15W <br /> Original Description(or attach copy): GL 3 !lyg N of Greer&W of Leef <br /> h <br /> N 3 <br /> bCurrent Zoning: RR1 Floodplain Y/N: N — , etlands Y/N: — Lake/River Class: <br /> tA <br /> aC T <br /> Name of Water Body: WAShoreland Agreement/SIPS Y/N: <br /> Farmland Preservation YIN: N Managed Forestry Law YIN: N <br /> New Parcel Information �� <br /> Proposed New Legal Description and Parcel Size: 2 Lot CSM c.‘. • <br /> '51 <br /> Acres: 4.., <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) r <br /> a <br /> Proposed access to public road: C� <br /> a <br /> Proposed access to public waters to be provided Y/N: f9 <br /> If yes, describe access: ,. <br /> N. <br /> Signature of Owner: fa 6.1-4, Date: 1(" - -/ G <br /> Signature of Owner: Date: c <br /> 8 <br /> ii <br /> > Does parcel meet Zoning Requirements? Yes No 46 A D s r-/ r., li <br /> g.N D Does parcel require a Survey? Yes NoTo <br /> Permit application fees submitted? 0 Amount$ 3a), Receipt# <br /> (� <br /> w l Reconciles with Real Property Lister c) No Date: VZ„- V:1-2 <br /> 0 <br /> °' If not,explain: • <br /> r <br /> o <br /> o. <br /> Applicatio Approve J) Denied Reason for Denial: <br /> Land Use: / /y ZO 21 Date: <br />