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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: S200.00+$50.00/lot <br /> Owner: DJ Christian Family Trust Buyer: DJ Chritsian Family Trust <br /> -o <br /> Address: 12926 County Rd 0 Address: 12926 County Rd 0 i <br /> z <br /> Grantsburg, WI 54840 Grantsburg, WI 54840 <br /> Phone: 715-488-2797 Phone: 715-488-2797 y <br /> Original Parcel Information , <br /> Parcel ID#: 07-034-2-37-18-18-3 03-000-011000 Section 18 Township 37 Range 18W <br /> Original Description (or attach copy): See Addendum for Legal Description o <br /> L— <br /> Current Zoning: Floodplain Y/N: Wetlands Y/N: Lake/River Class: T <br /> Name of Water Body: Shoreland Agreement/SIPS Y/N: <br /> .. Farmland Preservation Y/N: Managed Forestry Law Y/N: <br /> 4I <br /> New Parcel Information <br /> 1 <br /> Proposed New Legal Description and Parcel Size: See Addendum for Legal Description and Map <br /> Acres: p-A <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: C7 <br /> m <br /> Proposed access to public waters to be provided Y/N: <br /> R) <br /> If yes, describe access: <br /> Signature of Owner - fr5 - ( '' ( Date: O / "`?(, 3 <br /> Signature of Owner (--24 f , Date: 4'y/S.-c710c 3 o <br /> a <br /> i Does parcel meet Zoning Requirements? Yes No ((� ��/nJ(( 7, <br /> N EC IIVE- <br /> °o . Does parcel require a Survey? Yes No <br /> °fQ ➢ Permit application fees submitted? ❑ Amount$ 7a� ��o <br /> 1 JUN 2 l __/_ IS <br /> ®3Reconciles with Real Property Lister No Date: ,•�i. ► A:. t' <br /> mett <br /> c' Land .ervices Department <br /> If not,explain: p <br /> fD <br /> 0 <br /> a <br /> Applica ' Approved / De ied Reason for Denial: <br /> e__ /0,L z 3-402_, <br /> Land Use: <br /> y..,,,,...-- Date: 01ZOZ3 <br />