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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 or Map Review Form Subdivision w/Survey: $200.00+$50.00/lot <br /> b <br /> Owner: Steven M & Nancy C Rogers Trust Buyer: Josh A & Heidi Boxx <br /> i. <br /> Address: 3492 Richey Rd Address: 3690 Tamara Drive o <br /> Webster, WI 54893 Eau Claire, WI 54701 <br /> Phone: 952-908-3333 Phone: 715-214-9806 <br /> i <br /> 07-012-24-15-24-5 05-001-016000 Original Parcel Information <br /> 07-012-2-40-15-24-5 05002-012000 <br /> Parcel ID#:07-012-2-40-15-24-5 05-001-015000 Section 24 Township 40 N Range 15 W <br /> O <br /> Original Description(or attach copy): See attached. a <br /> a <br /> fD <br /> n <br /> Y <br /> .§, <br /> Lake <br /> Current Zoning: RR2 Floodplain Y/N: Y Wetlands Y/N: Y Lake/River Class: fn- <br /> Name of Water Body: Birch Island Lake Shoreland Agreement/SIPS Y/N: <br /> ,a <br /> b <br /> Farmland Preservation Y/N: Managed Forestry Law Y/N: <br /> a r, <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: Sale to adjoiner <br /> Acres:6.70 acres total <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) d <br /> Proposed access to public road: Existing driveways on existing easement to public road. 2pc <br /> Proposed access to public waters to be provided Y/N:N <br /> 0" <br /> If yes,describe access: <br /> P.30 Signature of Owner: Date: Z <br /> Signature of Owner: Date: ' ' <br /> vl <br /> Y Does parcel meet Zoning Requirements? Yes No dc CPO 31'Z <br /> ..•-1N Y Does parcel require a Survey? Yes No <br /> E. Od, oo �1 <br /> Permit application fees submitted? ❑ Amount$ / Receipt# <br /> aa <br /> ® Reconciles with Real Property Lister es No Date: 7- IA-0)Q °0 <br /> a If not,explain: S-11 <br /> aa <br /> n <br /> 0 <br /> n. Application: 44 i 8 rov•_, :e Reason for Denial: <br /> . <br /> Land Use: '� - g°S 7..e2.-2Date: <br />