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Fees(must accompany form): <br /> . <br /> Subdtvision wlo Survey: $30.00 <br /> Burnett County Subdivision Permit Application Sumvey ofEsiitingParcel: $50.00/lot <br /> and/or Pre-Application'FormSubdivision w/Survey: 3200.00+350.00/10t <br /> s5 <br /> Owner: Robert Gustafson Estate Buyer: '0 i <br /> 10360 Ridge Rd <br /> Address: <br /> Address: 4 <br /> Danbury Wi 54830 <br /> et 1 <br /> t-'. <br /> Phone: Phone ti., <br /> Original Parcel Information <br /> „. 07-036-2-40-17-30.4 01-000-012000 section 30 Township Range 17W <br /> . ID#: i4 <br /> Parcel <br /> .a <br /> tOrigiuxl Description(or attach copy): NE-SE Lyg S&E of Clam River Flowage = - <br /> :I <br /> i; <br /> ' Current Zoning: RR1 Floodplain Y/N: Y Wetlands Y LakeiRiverClass: <br /> v_ <br /> Name of Water Body: Clam River Flowage Shoreiand Agreement/SII'S Y/N: <br /> Farmland Preservation YIN:N Managed Forestry Law Y/N:N <br /> Air <br /> New Parcel Information <br /> CIA <br /> Proposed Newl.egal Description and Parcel Site: CSM divide existing lots ` ,', <br /> '',-r,.,*;, Acres: ., A a: <br /> (If parcel is to be suns eyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: �=7 ” <br /> m <br /> t-,- <br /> Proposed <br /> Proposed access to public waters to be provided Yi : <br /> IIf yes,describe access: <br /> Signature of Owner: ;-Cf C Date: 54.,-1 ! s <br /> 14 Siwnatetre of Owner: <br /> Date° ,.. <br /> 71 l.)oes pareJ meet Zo:Iiing Rerpiearents2 Yes No r <br /> r Dols parcel regtfire �urvpy�' Yes No <br /> on ` <br /> i> Permit application fees submitted? LT mount$ _— Receipt;k <br /> IGI <br /> Reconciles with Real Property Lister Yes_ No Date: `�`;�- _i ----s_i <br /> E. -,-.iIf not,explain:_ <br /> o <br /> t <br /> a t,. <br /> ,_ <br /> Application. Approved / Denied Reason for Denial: <br /> bind Use Fate: . <br /> Get Outlook for iOS <br /> /o 4n / ptI ,io4n$ <br /> V a4=d�t 7 <br /> el(lo CJ Ped7' i r�°e_ c J oil a/ !)/ty(/10 tie <br /> ✓` U f pe.viti41,7 , ivyCU f or- it ezen p h744/•e,v- <br /> r L <br /> /5 re f tt (ft to/ a% Y-6,5fl-- 1Me__) <br /> 000?_?.....• <br />