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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+$50.00/lot <br /> Alan &Janice Niedfeldt Voyager Village POA <br /> Owner: Buyer: b <br /> e9 <br /> Address: 28402 Kilkare Rd Address: 28851 Kilkare Rd a <br /> Danbury WI 54830 Danbury WI 54830 k. <br /> ..c <br /> va <br /> Phone: Phone: <br /> Original Parcel Information v,, <br /> 07-012-2-40-15-14-5 05-006-011000 (1) <br /> Parcel ID#: 07-012-2-40-15-14-5 15-859-080000 Section 14 Township 40N Range 15W <br /> 07-012-2-40-15-14-5 15-859-081000 <br /> Original Description(or attach copy): a <br /> es <br /> GL 6 & Prt GL 7, Wintergreen Add to VV Outlots 1 &2 of replat 1, 2 &3 <br /> o <br /> PUD <br /> Current Zoning: RR3 Floodplain Y/N: N Wetlands Y/N: Y Lake/River Class: <br /> iv <br /> o Name of Water Body: N/A Shoreland Agreement/SIPS Y/N; <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N: <br /> New Parcel Information 1 11 <br /> il <br /> Proposed New Legal Description and Parcel Size: '7) tt, <br /> G Q,• <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: C7 <br /> a <br /> Proposed access to public waters to be provided Y/N: ';� <br /> If yes,describe access: C� <br /> NN <br /> Signature of Owner: Ca-¢i't L / ' I Date: 5///.26;-,)- t) <br /> Signature of Owner: 9a; f..A.,66)‘XS24,J ° j Date: // g <br /> ➢ Does parcel meet Zoning Requirements? Yes Noet <br /> N <br /> ➢ Does parcel require a Survey? Yes No <br /> rEF,,, <br /> 9 2C2 ,°Q ➢ Permit application fees submitted? ❑ Amount$ , j Rt# t i G <br /> Burnett County , `� <br /> ® Reconciles with Real Property Lister CEED No Date: taervices Department <br /> = <br /> ° If not,explain: .^C. <br /> gd <br /> el <br /> 0 <br /> n <br /> H V\ <br /> Applicatio p. iv•i 1 • •'ed Reason for Den' l:7 <br /> ,�- /O/ zDZZ <br /> Land se: / Date: <br />