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Burnett County Subdivision Permit Application i Fees(must accompany form): <br /> and/or Pre-A lication Form or Ma Review Form Subdivision w Survey.: 55o.0u <br /> Pp p i Survey of Existing Parcel: 550.00/lot <br /> 1 Subdivision w Survey: 5200.00+S50.00/lot <br /> Daniel Chelmo <br /> Owner: Buyer: A <br /> Address: P 0 BOX 397 Address: 3 <br /> WAUTOMA WI 54982 0 <br /> 't <br /> C <br /> m <br /> Phone: Phone: s <br /> 07-018-2-39-16-04-5 05-001-011001 Original Parcel Information 07-020-2-40-16-33-5 <br /> 07-018-2-39-16-04-1 03-000-011001 <br /> 43g 16 <br /> Parcel ID#: 018330404300, 018330404600 Section 33 Township 40 Range 16 4 <br /> Original Description(or attach copy): GL 1 EXC CSMS: V1 P259 & 261. V2,P23, & V24 P158, Sec. 4 fD <br /> SW NE EX CSM#4441 V24 P158, NE NW, SE NW, Sec.4 <br /> arld that part GL_ 4 described as Daniel Dr. on CSM V28, p.296-298. Sec. 33 <br /> �. <br /> Current Zoning:A-2 & RR-1 Floodplain YIN: N Wetlands YIN: N Lake/River Class: NiA <br /> .o Name of Water Body: N/A Shoreland Agreement/SIPS YIN: N <br /> m Farmland Preservation Y/N: N Managed Forestry Law YIN: N <br /> o <br /> New Parcel Information 0 <br /> Proposed New Legal Description and Parcel Size: Under the provisions of Density Development, <br /> this remnant parcel will be merged into one 45.9 A lot. <br /> Acres: 45.9 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. Lz <br /> m <br /> Proposed access to public waters to be provided YIN: N <br /> If yes,describe access: '� <br /> Signature of Owner: Date: 04 ©8 -Z O-2,.2„_,, C� <br /> n <br /> signature of owner: mate: ©: <br /> 3 <br /> le <br /> e <br /> v Does parcel meet Zoning Requirements? Yes \ /3 3 7 et <br /> It <br /> ➢ Does parcel require a Survey:' Yes No <br /> E. <br /> Permit application fres submitted? ❑ Amount . O 4- „ ,,, !ii, -- <br /> cel <br /> ® Reconciles with Real Property Lister Q No Date: 5_ct _ ZZ <br /> oIf not,explain: `m <br /> a <br /> of <br /> ft <br /> a Application: .- pp e, Denied Reason for Denial:ft <br /> C)0 <br /> -.011111111, <br /> Land Use: 1111, S/ We-2_ Date: <br /> -AI; C r 00,71-07c4.. - I . ” " ea at *iITL •x) e <br /> c <br />