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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br /> and/or Pre- lication Survey of Existing Parcel: $50.00/lot <br /> ApF Form vision wi survey szoo.00+$so.00not <br /> Owner: Eileen Strohbeen <br /> Buyer: <br /> Address: 7548 County Rd U Address: <br /> Danbury WI 54830 <br /> Phone: Phone: <br /> Original Parcel Information <br /> 07-020-2-40-16-20-615-930-058000, <br /> Parcel ID#: 059000,020000,019000 section 20 Township 40N Range 16W <br /> Original Description(or attach copy): Village of Yellow Lake Plat Lots 1-12 Blk 9,Blk 10. <br /> Lot 1 &2 BIk 3&vacated roads&alleyways <br /> Current Zoning: RR1 Floodplain YIN: N Wetlands YIN: N Lake/River Class: <br /> N/A <br /> Name of Water Body: Shoreland Agreement/SIPS Y/N; <br /> Farmland Preservation YIN: N Managed Forestry Law Y/N: N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: CSM ccimbine tots <br /> Acres: <br /> (If parcel is to be surveyed,provide y map. See attached for preliminary map requirements.) <br /> Proposed access to public read: <br /> Proposed access to public waters to be provided YIN: <br /> If yes,describe access: <br /> Signature of Owner: Date. —/ Z—. <br /> Signature of Owner: Date: <br /> ➢ Does parcel meet ZoningRegruirements? Yes No <br /> D Does parcel require a Survey? Yes No <br /> °4 ➢ Permit application fees submitted? 0 Amount$ Receipt# <br /> ❑Reconciles with Real Property Lister Yes No Date: <br /> 7d If not,esplam' <br /> ti <br /> ts. <br /> Application: Approved / Denied Reason for Denial: <br />