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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+$50.00/lot <br /> Owner <br /> Cwuer: William &Melisa Mulroy Patricia Norskog <br /> eD <br /> MAX <br /> Address: 24804 Old 35 Address: 24830 Old 35 03 <br /> Siren WI 54872 Siren WI 54872 <br /> Phone: Phone: G <br /> Original Parcel Information <br /> 07-018-2-39-16-32-3 03-000-011000 <br /> Parcel ID#: Section 32 Township 39N Range 16W C31 <br /> Original Description(or attach copy): SW-SW ex N 100' ' <br /> tv <br /> RR2 N N .? ''‘ <br /> b Current Zoning: Floodplain Y/N: Wetlands Y/N: Lake/River Class: .D„ <br /> .on 9. <br /> Name of Water Body: N/A Shoreland Agreement/SIPS Y/N: P <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N: N <br /> New Parcel Information (`� <br /> r <br /> Proposed New Legal Description and Parcel Size: 2 lot CSM <br /> A <br /> C 1 <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: C7 <br /> .F <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: <br /> 6 3 ki, 3 •� <br /> '" �>.: .�'i'�"� j� c.��� ���•'lt3 �-. Date: �o'. <br /> T' /- 6 q, ca r. <br /> ,',, x �, v 1 a.-�41 :e>c o 3 — a n <br /> Date 0 <br /> 2 <br /> > Does parcel meet Zoning Requirements? Yes No q. .5 <br /> clk_o <br /> p > Does parcel require a Survey? Yes No <br /> dD <br /> 00 > Permit application fees submitted? ❑ Amount$ �°' ' Receipt# <br /> W <br /> d 0 Reconciles with Real Property Lister Yes No Date: ( 7/12/2DZ 3 .-C <br /> a <br /> c If not,explain: <br /> n <br /> 0 <br /> a <br /> Applicatio I Approved ! •'lied Reason for Denial: <br /> Land Use- Date: /// ?,OZ_3 _� <br />