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AuthentisignID:DB68F6EF-8E93-ED11-AC20-0050F2765AB1 <br /> 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+$50.00/lot <br /> Owner: Blake Vitale Buyer: ,tiy <br /> to <br /> Address: 22592 Assembly Dr Address: <br /> Grantsburg WI 54840 c <br /> G <br /> FP <br /> Phone: Phone: <br /> Tea <br /> Original Parcel Information v' <br /> Parcel ID#: 07-010-2-38-19-21-1 04-000-011000 Section 21 Township 38N Range 19W 6 <br /> O <br /> Original Description(or attach copy): SE-NE ex S 10 of W 115' <br /> n <br /> .i • <br /> .o Current Zoning: RR3 Floodplain Y/N: Y Wetlands Y/N: Y Lake/River Class: <br /> Ir Wood River <br /> Name of Water Body: Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N: N New Parcel Information (I <br /> Proposed New Legal Description and Parcel Size: <br /> 2 lot CSM <br /> Acres: 39.4 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: Johnson Rd tv <br /> Proposed access to public waters to be provided Y/N: <br /> 113 <br /> If yes,describe access: �� <br /> Alnnenm.,, <br /> S fure f er' [WrSE VITAE E 01/13/23 <br /> Signature of Owner: Date: o <br /> 5 <br /> e <br /> N > Does parcel meet Zoning Requirements? Yes No ‘D 7 C�� e <br /> E. ➢ Does parcel require a Survey? Yes No <br /> U° > Permit application fees submitted? ❑ Amount$ 3 t0c9' Receipt# <br /> t., 0 Reconciles with Real Property Lister Yes No Date: 0 <br /> ry <br /> If not,explain: <br /> 7d <br /> © <br /> y <br /> Applicatio (. 'rove. 3P enied Reason for Denial: <br /> Land Use: �ca ��c,�— - Date: Z/Z/ e-12 Z� <br /> PUI s U Y'Leyo r' /c t-f 5€ 77 �Q$74-/I H L 6.., z.,/- z <br /> /5 i-h /,i e. a S sLJo Lt pi 4 0 74- /- e r 1/e.✓'. <br />