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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+$50.00/lot <br /> OWNER <br /> Owner: Robert Kaltman BBu :`� David Engstrand Jr „d <br /> ro <br /> Address: 13033 County Road Z Address: 13018 County Road Z <br /> a <br /> Grantsburg, WI 54840 Grantsburg, WI 54840 P <br /> KY <br /> Phone: '7/i' `7'31- D`/yr Phone: 715-554-0516 G <br /> Original Parcel Information W <br /> Tax ID: 663 PIN: 07-002-2-37-19-36-1 01-000-011000 <br /> Parcel ID#: Tax ID: 664 PIN: 07-002-2-37-19-36-1 01-000-012000 Section 36 Township 37 Range 19 <br /> Original Description(or attach copy): Part of the NE1/4—NE1/4 A <br /> n <br /> as described in Doc.# 165104 and 447989 <br /> .ii\l <br /> b <br /> so Current Zoning: A2 Floodplain Y/N: Wetlands Y/N: -- , 't <br /> Lake/River Classification: Name of Water Body: R� <br /> 1 <br /> Shoreland Agreemt or SIPS Y/N: Farmland Preservation Y/N: Managed Forestry Law Y/N: <br /> New Parcel Information !fit <br /> Proposed New Legal Description and Parcel Size: Proposed CSM 0—. <br /> (No new lots — Prepared to facilitate agreement between adjacent owners to enlarge the Engstrand parcel) <br /> Acres: 3.14 A c.± <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: County Road Z and Range Line Road C7 <br /> m <br /> Proposed access to public waters to be provided Y/N: <br /> If yes, describe access: �'Signature of Owner: # J,.r l li Date: //6/2, <br /> , _ <br /> --1 <br /> Signature of Owner: L /.�--- � i/ ( Date: �-- /0 "_c ,� <br /> v <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> o e,G 5�S�Z fo � c/g D <br /> B' ➢ Does parcel require a Survey? Yes No c/te..* <br /> _ Oo c.,&.lt z 9'ov 2�1 <br /> n <br /> Permit application fees submitted? 0 Amount$ 2 v Receipt# <br /> F <br /> ti:1 Reconciles with Real Property Lister (ID No Date: 5-18-aaa?3 <br /> 0 <br /> a .rt- <br /> If not,explain: <br /> A <br /> 0 <br /> o. is <br /> Application- pproved / enied Reason for Denial: <br /> Land Use: 0/33 Date: <br />