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. Fees(must accompany form): <br /> BtiriTtll ClUr Subdivision Permit Application Subdivision w/o Survey: $50.00 <br /> Survey of Existing Parcel: $50.00/lot <br /> apElgof1)282 ppl ation Form or Map Review Form Subdivision w/Survey: $200.00+$50.00/lot <br /> 1501P h-79 b <br /> P <br /> e <br /> wer Burnett tXen Pete son Buyer: BRCC, LLC <br /> La J6rVICe, cpaitl net;t + <br /> Address: 1768 250th Street Address: 2181 45th Avenue o <br /> cn <br /> Emerlad, WI 54013 Star Prairie, WI 54026 <br /> cc <br /> Phone: Phone: 612-849-1465 W <br /> Original Parcel Information t <br /> Parcel ID#: See attached statements Section 25 Township 40N Range 16W <br /> O <br /> Original Description(or attach copy): See attached statments <br /> a <br /> Current Tax ID#s: 13651 /13652 ,• <br /> Current Zoning: /4.-2--"Floodplain Y/N: N Wetlands Y/N: Y'eS ke/River Class: (-1 3 <br /> d Name of Water Body: Shoreland Agreement/SIPS Y/N; N <br /> a <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N: N <br /> a <br /> New Parcel Information D <br /> Proposed New Legal Description and Parcel Size: See attached Deed <br /> New Tax ID Nos.: 36428/36429 <br /> Acres: Approx:6/14 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) t7 <br /> a <br /> A <br /> Proposed access to public road: .� <br /> Proposed access to public waters to be provided Y/N: N <br /> If yes, describe access: <br /> 9 ►d <br /> Signature of Owner: .. Cil_ -t�-2 l'� f ',7 �._ Date: / - / - :-3i z <br /> Signature of Owner: Date: <br /> W <br /> > Does parcel meet Zoning Requirements? Yes No <br /> c-. <br /> c N <br /> ➢ Does parcel require a Survey? Yes No 44 <br /> a <br /> ➢ Permit application fees submitted? ❑ Amount$ Receipt# 1- <br /> cro <br /> © Reconciles with Real Property Lister No Date: a'15-c,3 <br /> C" N <br /> aParse tg a►rea sQ►�+. see mix tos �b4�8 319 -Q <br /> a. <br /> 0 <br /> ° Application: Approv d ' d Reason for Denial: <br /> Land Use: /,, .,,- - z///zoz3 Date: <br /> iiiti�i it�i 41_ 6Te/cl" J'e-- . 7fiT`?eNWAi'713 <br />