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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+$50.00/lot <br /> Owner: Todd Anderson Buyer: <br /> ro <br /> Address: PO Box 483 <br /> i.Address: <br /> Grantsburg WI 54840 c <br /> Phone: Phone: <br /> Original Parcel Information via <br /> Parcel ID#: 07-002-2-37-19-26-4 04-000-011200 Section 26 Township 37N Range 19W <br /> 07-002-2-37-19-26-4 04-000-011100 C <br /> Original Description(or attach copy): = <br /> SE-SE (Ex N Sac)& S660 of E660 :i <br /> oA <br /> v Current Zoning: A2 Floodplain Y/N: N Wetlands Y/N: N Lake/River Class: es <br /> b <br /> oName of Water Body: N/A iShoreland Agreement/SIPS Y/N; <br /> P. <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N: N <br /> 0 <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: 2 lot CSM <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: Erickson Road C <br /> m <br /> Proposed access to public waters to be provided Y/N: N <br /> If yes,describe access: <br /> t) <br /> Date: -- 0'- 2---. <br /> Signature of Owner: Date: o <br /> b <br /> > Does parcel meet Zoning Requirements? Yes No <br /> eo <br /> N � <br /> ➢ Does parcel require a Survey? Yes No w <br /> O <br /> ,v� d <br /> °Q ➢ Permit application fees submitted? ❑ Amount$ /Do I Receipt# T. <br /> m ® Reconciles with Real Property Lister (I es) No Date: t-18-c23 <br /> .rye <br /> 10 <br /> n. If not,explain: V1 <br /> v <br /> o <br /> 0 <br /> . <br /> Application A�• l Denied Reason for Denial: <br /> Land Use: / / Gv Z 3 Date: <br /> IA fryLL1'& /0.,„,./ O !tiI - Pyr til.s /e9A___. <br /> ( v 1 3 7 t- a c w_..5 ? T-/ CA l7LS <br /> tot / 2 lA ZO/-Z - / ai / - <br /> fcccvN‘+ be tx1'v,(ze L <br />