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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+$50.00/lot <br /> Mark Bandyk • <br /> Owner: Buyer: ,.,y <br /> eo <br /> Address: 1243 County Rd E Address: <br /> Spooner WI 54801 M <br /> ••C <br /> CA <br /> Phone: Phone: 1 <br /> OriEinal Parcel Information N <br /> Parcel ID#: 07-028-2-40-14-24-5 15-210-015000 Section 24 Township 40N Range 14W N <br /> 016000, 017000, 018000, 019000, 020000 O <br /> Original Description(or attach copy): g <br /> Peron Park Lots 4-9 <br /> .o Current Zoning: RR1 Floodplain Y/N: Y Wetlands Y/N: N Lake/River Class: <br /> b <br /> Big McKenzie Lake <br /> R* Name of Water Body: Shoreland Agreement/SIPS Y/N: <br /> 0 <br /> T <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N: N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: 2 lot CSM <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: p <br /> m <br /> m <br /> Proposed access to public waters to be provided Y/N: `'-.1 <br /> If yes,describe access: V\ <br /> g2j¢ w: It'l 4712aAA Gj41,.4e L/� Date: 7/12/22 <br /> Signature of Owner: Date: " <br /> 3 <br /> > Does parcel meet Zoning Requirements? Yes No <br /> E > Does parcel require a Survey? Yes No ' <br /> ] 2 (9°> Permit application fees submitted? 0 Amount$ 7��i Receipt# (�,1 <br /> aReconciles with Real Property Lister 'Ts No Date: 7 - I3 —oZ <br /> a If not,explain: UI <br /> o `fkl <br /> ApplicatioApprove vied Reason for Denial: <br /> Land Use: ®z� <br /> Date: / Z' V+ <br />