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Burnett County Subdivision Permit Application Fees(must accompany fond): <br /> and/or Pre-Application Form or Map Review Form Subdivision w Survey: $50.00 <br /> Survey of Existing Parcel: $50.0011ot <br /> Subdivision w Survey: 5200.00<S50.00/lot i <br /> Daniel Chelmo <br /> Owner: Buyer: A <br /> Address: P 0 BOX 397 Address: i. <br /> WAUTOMA WI 54982 z <br /> G <br /> zo <br /> Phone: Phone: yL <br /> 15' <br /> Original Parcel Information <br /> 07-018-2-39-16-04-5 05-001-01100' J <br /> Parcel ID#: 07-018-2-39-16-04-1 03-000-011001 Section 4 Township 39 Range 16 <br /> Original Description(or attach copy): GL 1 EXC CSMS' V1 P259 & 261 , V2,P23, & e, <br /> V24 P158 <br /> SW NE EX CSM#4441 V24 P158 <br /> Rh, <br /> Current Zoning: A-2 Floodplain ViN: N Wetlands YIN: N Lake/River Class: N/A (r\ <br /> Name of Water Body: t` - Shoreland Agreement/SIPS Y/N: N `; " <br /> At <br /> m Farmland Preservation Y/N: N Managed Forestry Law Y/N: N <br /> New Parcel Information Q <br /> Proposed New Legal Description and Parcel Size: 4 Lots are created between Daniel Dr. and <br /> South Devils Lake Road by CSM. This used the provisions of Density Development. <br /> A CSM of the 44 acre remant is pending Acres: 12.5 A <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: Direct Access to CTH A and Daniel Dr. <br /> A <br /> Proposed access to public waters to be provided Y/N: 7 -\\ <br /> If yes,describe access: Mr. Chelmo is looking at options. <br /> Signature of Owner: Date: o t.( _O g —ZOZZ 1) <br /> n <br /> Jignature of owner: uate: 3 <br /> C <br /> Does parcel meet Zoning Requirements:' }'c., A, C. ,. <br /> > Does parcel require a Survey? Yes .A <br /> O od UV <br /> p <br /> > Permit application fees submitted? Ell Amount S (1),0, Pc,cip =' U1 <br /> rc <br /> 0 Reconciles with Real Property Lister Yes No Date: b <br /> o If not,explain: <br /> a <br /> n <br /> A <br /> O <br /> a Applicatio (4111=1110 Denied Reason for Denial: ' <br /> Land Use: � s C ",/ !' /64o, 4�./ /L IW "eJi4 at• iID 1 D ✓�T/ SIO=,� <br /> 4IL /*` /!` - e'e. `:/,,,M17, tiiiii 5 /Z 2O2,2.- <br />