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Dec 27 22, 12:35p Welcome Home Quality Care 7153497712 p.2 <br /> Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision wio Survey: S50.00 <br /> Survey of Existing Parcel: $50.00/lot <br /> and/or Pre-Application Form subdivision w/Survey: S200.00+S50.00/1m <br /> Linda Kinch <br /> Owner: Buyer: A <br /> 24134 Daniel Johnson Rd P. <br /> Address: Address: •: <br /> Siren WI 54872 °N <br /> C. <br /> 715-790-7039 u' <br /> Phone: Phone: lv <br /> Original Parcel Information N <br /> 07-018-2-39-16-03-5 05-002-035000 39 Range16 <br /> Parcel ID#: 07-018-2-39-16-03-5 05-002-034000 Section 03 Township <br /> 1 <br /> Original Description(or attach copy): GL2 A <br /> ri <br /> .S Current Zoning: A2 Floodplain Y/N: Y Wetlands YIN: Y Lake/River Class: <br /> el' Name of Water Body: Yellow River Shoreland Agreement/SIPS Y/N: t) <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N: N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: <br /> CSM combine lots C) <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> a: <br /> n <br /> Proposed access to public waters to be provided YIN: <br /> If yes,describe access: lie <br /> Signature of Owner: e-1/12. -,C-4.;;;Le Date:l,2 23 24�.�1 <br /> Signature of Owner: Date: 2 <br /> G <br /> ) Does parcel meet Zoning Requirements? Yes No de,# 07 Z• S <br /> o ➢ Does parcel require a Survey? Yes No <br /> o. °�- <br /> Del > Permit application fees submitted? 0 Amount S SSA' Receipt# •� <br /> IU <br /> r, 0 Reconciles with Real Property Lister Yes No Date: <br /> is- <br /> 10 <br /> If not,explain: dh <br /> n <br /> o <br /> Application A rov ied Reason for Denial:1 /� <br /> Land Use: NI <br /> �^�' - i�y/'oZZate: <br />