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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+$50.00/lot <br /> Owner: David &Cheryl Smith Margel Ruck Trust <br /> es <br /> eo <br /> 1247 230th St 29015 Old 35 Rd g. <br /> Address: Address: <br /> Glenwood City WI 54013 Danbury WI 54830 e <br /> C <br /> Phone: Phone: CA <br /> Original Parcel Information Ntv <br /> 07-020-2-40-16-09-3 02-000-012000 <br /> Parcel ID#: 07-020-2-40-16-09-3 02-000-013000 Section 09 Township 40N Range 16W <br /> O <br /> Original Description(or attach copy): SW-NW& NW-NW, prt of NW-SW lyg E of State Rd 35 <br /> eo <br /> b <br /> A2 N N <br /> b Current Zoning: Floodplain Y/N: Wetlands Y/N: Lake/River Class: Xer <br /> N/A <br /> o Name of Water Body: Shoreland Agreement/SIPS Y/N: <br /> T Farmland Preservation Y/N: N Managed Forestry Law Y/N: N ,^-f <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: CSM change lot lines `( <br /> 1-- <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: C <br /> t <br /> Proposed access to public waters to be provided Y/N: <br /> N <br /> If yes,describe access: <br /> b <br /> Signature of Owner: Q . /f Date: /lam eV`0Za N <br /> z-APB e^-a�-�02. n <br /> Signature of Owner: Date: c <br /> g <br /> .fl <br /> 3 <br /> > Does parcel meet Zoning Requirements? Yes No 10 7� n <br /> N <br /> 7 ➢ Does parcel require a Survey? Yes No <br /> afro ..�' - <br /> Permit application fees submitted? ❑ Amount$ /2Oi Receipt# <br /> C <br /> tH <br /> rg Reconciles with Real Property Lister es No Date: 12.-t3-a(2 <br /> a <br /> a. If not,explain: <br /> �J <br /> A Ja <br /> n <br /> o 1 <br /> �t p <br /> G <br /> h i_ <br /> Applicatio i Ap i ro •. Denied Reason for Denial: <br /> Land Use: / / 00Zz-mate: <br />