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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: S50.00 <br /> Survey of Existing Parcel: S50.00ilot <br /> and/or Pre-Application Form Subdivision w!Survey: S200.00+S50.00/lot <br /> Owner Frances Guziec Trust <br /> Owner: Michael McManus XO•: <br /> 43 Folly Field Rd Apt 36 Address: 222 Prairie Pedal Ln <br /> Address: - <br /> Hilton Head Island SC 29928 Sharon WI 53585 <br /> Phone: Phone: tJ <br /> Original Parcel Information N <br /> 07-028-2-40-14-07-5 05-002-013000 Q <br /> Parcel ID#: 014000, 015000 ►-r7 Tax ID } Section 28 Township 40N 14W <br /> v0 Range <br /> GL 2 t7794 Tax ID <br /> z <br /> Original Description(or attach copy): <br /> z <br /> 3 <br /> i. <br /> Current Zoning: RR2 Floodplain Y/N: Y Wetlands Y/N: N Lake/River Class: <br /> 'F-• Birch Island Lake <br /> ., Name of Water Body: b Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation YIN: N Managed Forestry Law Y/N: N P j3? <br /> New Parcel Information I.7 <br /> Proposed New Legal Description and Parcel Size: 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: C <br /> m <br /> T <br /> eD <br /> Proposed access to public waters to be provided Y/N: <br /> If yes, describe access: <br /> Signature of Owner:,7„�..,,,;,, ,. .,_,0. Date: Sep 15, 2022 <br /> Signature of Owner: Date: <br /> Does parcel meet Zoning Requirements? Yes No <br /> l - (polo 0 <br /> 2 > Does parcel require a Survey? Yes No <br /> 00 ,.1 ..1 <br /> " > ID� Permit application fees submitted? Amount$ 100, Receipt# ,J <br /> N0 %3 <br /> tinReconciles with Real Property Lister leall No Date: 1-a0-a• 1/4...-0 <br /> o IN <br /> If not,explain: Otl <br /> r <br /> Application. Approv enied Reason for Denial: <br /> p. <br /> Land Use: �l 7ip L�— Date: � <br />