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fsea(ffiust accompsay lam; <br /> Burnett County Subdivision Permit Application subdivigiouvAs y: iSo:oo <br /> and/or Pre-Application Form Survey Puna � o:oon®t <br /> Owner; Pamela Calyn Bern Fox Ridge Trace Address: <br /> it <br /> Danbury WI 548301 <br /> Phone: 715-914-7183 Phone: <br /> Orls*inal Parcel Inf atiog I <br /> pared wok 07-012-2-40-15-15-5 15-271-056000&057000 Section 15 Townahi 40N Rapp 15W <br /> ovum Description*atta&roPy)z Hawks Nest Add to VV Lots 46 &47 <br /> 4 <br /> arrest : PUD Floodplain YIN: N Wetlands Y/N: N Lake/River Class: <br /> i Name of Water Body: N/A Shoreland Agreement/SIPS Y/N: <br /> ' Farmland Preservation Y/N:N Managed Forestry Law Y/N:N <br /> 4ew Parcel Information ) <br /> Proposed New Leal Description and Parcel Sin: CSM combine 2 existing lots <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> _k Proposed access to public waters to be provided Y/N: <br /> Hrs.describe access: _ <br /> re of Owner: i'r, ' Date: <br /> S <br /> Simeat ure of Owner: Date: <br /> la Does parcel meet&Wee Requirements? Yes No ded, G 05// <br /> r Does parcel require a Survey? Yes No <br /> n Od <br /> °° ul <br /> ), Peru application fees submitter 0 Amount$ .7v' Receipt# .t <br /> 00 <br /> III Reconciles with Real Property Lister No Date: iZ-22--2.. -')- <br /> E. J <br /> H edam_ til <br /> ..t <br /> .0�. <br /> re <br /> Appl tion• proiDeoied Reason for Denial: <br /> Land Use: ,,_.— /�7$�ZODate: <br />