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Pecs(must accompany form): <br /> Burnett County Subdivision Per 1 '.t Application Subdivision w/o Survey: $50.00 <br /> Survey of Existing Parcel: $50.00/lot <br /> and/or Pre-Application = orm Subdivision w/Survey: $200.00+$50.00/lot <br /> Owner: Kathleen Mails ,Buyer: ►11 <br /> Address: 31064 Pine Lane , ddress: is <br /> Danbury WI 54830 i G <br /> 651-270-0012 1 <br /> Phone: Phone: <br /> /II ill <br /> Original P. el Information <br /> 07-032-2-41-15-17-5 05-002-01400!i VI <br /> Parcel ID#: 07-032-2-41-15-17-5 15 ''_-0 ,: .0+t Section 17 Township 41N Range 15W 11.1 <br /> Original Description(or attach copy): Lofty Pines dd Lot 25&GL 2 <br /> v Current Zoning: RR2 Floodplain Y/N: Y i Wetlands Y/N: N Lake/River Class: <br /> (0 <br /> 0 Name of Water Body: Tabor Lake I Shoreland Agreement/SIPS Y/N: <br /> R Farmland Preservation YIN: N I Managed Forestry Law Y/N: N 3 <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: ll l <br /> !' <br /> r <br /> li <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map' See attached for preliminary map requirements.) <br /> 11 <br /> Proposed access to public road: <br /> M <br /> Proposed access to public waters to be provided YIN: ;04. <br /> If yes,describe access: <br /> (.„ <br /> Signature of Owner: 7I)/ `%`%% :(Za_i <br /> Date: .2"Y�c;�c�,,,, <br /> Signature of Owner: i Date: o <br /> > Does parcel meet Zoning Requirements? ires No _ fe _,. CO -,3f. <br /> N (�� <br /> 0 > Does parcel require a Survey? res No <br /> s �- 2 k.) <br /> °Q ➢ Permit application fees submitted? El amount$ 7 D' Receipt# <br /> likS_ o <br /> ✓ la Reconciles with Real Property Lister CIO No Date: (�(,�c J �3 j.1 <br /> m <br /> cu If not,explain: , ..S\-)— <br /> r, <br /> o i k) <br /> d M <br /> Applicati roved / enied Reason for Dula: °6: <br /> Land Use: /�t� J Date: 23 <br />