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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: $200.00+$50.00/lot <br /> Owner: Ronald Yourchuck Buyer: <br /> YOURCHUCK LAND TRUST i <br /> Address: 24735 OLD HWY 35 Address: <br /> SIREN WI 5487 <br /> Phone: 715-349-2301 Phone: N <br /> Original Parcel Information ..1j <br /> Parcel ID#: 018333102600 Section 31 Township 39 Range 16 �V <br /> a <br /> Original Description (or attach copy): Part of the NE'/2-SE% <br /> 3 <br /> Current Zoning: RR-2 Floodplain Y/N: N Wetlands Y/N: N Lake/River Class: N/A <br /> c-C <br /> -a Name of Water Body: Shoreland Agreement/SIPS Y/N: N C <br /> .9 <br /> Farmland Preservation YIN: N Managed Forestry Law Y/N: N <br /> .. New Parcel Information <br /> Proposed New Legal Description and Parcel Size: A CSM is used to create two lots <br /> from the unplatted portion of the NE-SE. <br /> Acres: 2.22 A and 1.55 A <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: Yourchuck Lane - private road to Old 35. . <br /> m <br /> Proposed access to public waters to be provided Y/N: N <br /> If yes,describe access: <br /> Signature of Owner: ,t24.464, Z4.A.,8Z-e--At Date: ( 7_1 z o z <br /> z )n <br /> signature of owner: uate: ° <br /> 3 <br /> Ts <br /> e <br /> ➢ Does parcel meet Zoning Requirements? Yes No o fe--- 0 C/[/37 et <br /> It <br /> N > Does parcel require a Survey? Yes No <br /> Cm <br /> Is- <br /> S' > Permit application fees submitted? 0 Amount$ 349 O r �� Receipt# w <br /> ro <br /> ❑ Reconciles with Real Property Lister Yes No Date: <br /> W <br /> o If not,explain: <br /> VI <br /> eP U‘ <br /> S <br /> © <br /> CM <br /> a, Application- rove Denied Reason for Denial: <br /> Land Use: Date: <br /> Y. <br /> 9uc��. /D /8/ZO2 Z— l� <br /> r// <br />