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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> and/or Pre-Application Form or Map Review Form Subdivision w/o Survey: $50.00 <br /> Survey of Existing Parcel: $50.00/lot <br /> Subdivision w,Survey: 5200.00+$50.00/lot <br /> DEAN C SANDBERG <br /> Owner: Buyer: v <br /> eo <br /> Address: 12000 N FORK DR Address: g <br /> GRANTSBURG WI 54840 z <br /> C. <br /> Phone: Phone: '` <br /> Original Parcel Information <br /> 00 <br /> Parcel ID#: 042251602800 & 042251602700 Section 16 Township 38 Range 18 ot <br /> a <br /> Original Description(or attach copy): SE S1/W, EX CSM V 2 P 237 & EX <br /> L7l/\1V r ^r` 491/274 CY <br /> Including CSM V 1 P 14 <br /> Not Zoned&A-2 along River <br /> Current Zoning: Floodplain YIN:-.long River Wetlands Y/N: Along River Lake/River Class: N/A <br /> -a Name of Water Body: Wood River Shoreland Agreement/SIPS Y/N: N <br /> a Farmland Preservation Y/N: N Managed Forestry Law Y/N: N <br /> 7 <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: A CSM is used to reconfigure lot in CSM <br /> V.1, p.14., divide lands west of Lara Rd. and make an outlot of gap around CSM <br /> V. 2, p.237 <br /> Acres: 10.34 A <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Direct Access to Lara Road ° <br /> Proposed access to public road: - <br /> A <br /> Proposed access to public waters to be provided Y/N: N ��� <br /> If yes,describe access• ,� <br /> _k Signature of Owner: N..- (7.. � � Date: Jv <br /> signature of tJwner: nate: ° <br /> 3 <br /> a <br /> ➢ <br /> Does parcel meet Zoning Requirements? Yes No - 40C2/V6 3 5 <br /> N Does parcel require a Survey? Yes No <br /> DO <br /> E <br /> > Permit application fees submitter!? ❑ Amount$ . ..57)1I Receipt# <br /> NI <br /> 0 Reconciles with Real Property Lister Yes No Date: <br /> If not,explain: .J) <br /> a <br /> (30 <br /> na NI <br /> n. kpplication• Asproved lenied Reason for Denial: <br /> y Land Use: '�f.4rr� I • 2:7Z Z Date: l/ <br />