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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 or Map Review Form Subdivision w/Survey: $200.00+$50.00/lot <br /> ITS <br /> an <br /> Owner: Deborah Milner Buyer: el a <br /> 7921 Park St m z <br /> Address: Address: A c <br /> Danbury WI 54830 r '0 <br /> Phone: Phone: <br /> Original Parcel Information <br /> Tax ID#: 07-020-2-40-16-19-5 15-360-063000 section 19 Township 40N Range 16W <br /> Original Description(or attach copy):Jensen's Lakeshore Div of Yellow Lake Lots 2-3 BIk 9 <br /> i <br /> Current Zoning: RR1 Floodplain Y/N;Y Wetlands YIN: N Lake/River Class- <br /> ./ <br /> Name of Water Body:Yell ?. <br /> ow Lake Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation Y/N:N Managed Forestry Law Y/N: N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: CSM to combine 2 existing lots <br /> 7 <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) iyy <br /> Proposed access to public road: <br /> S <br /> Proposed access to public waters to be provided YIN: <br /> If yes,describe access: <br /> Signature of Owner: Date: is1/ � <br /> Signature of Owner: Date: , <br /> > Does parcel meet Zoning Requirements? Yes No Fee Rec: e'. <br /> Check#: PO81 <br /> > Does parcel require a Survey? Yes No m <br /> z <br /> z <br /> 0 <br /> 0 CD <br /> Reconciles with Real Property Lister 0 No Date: 0613 (1O3 <br /> m _o <br /> n <br /> If not,explain: a n 11 IYI 1 <br /> 0 S.. <br /> 2 a <br /> co En] <br /> 43 <br /> Applicatio Approved / enied Reason for Denial- .: 0 r cz=i <br /> s QZ <br /> 0 Q <br /> Lan e: Date: s 3 w <br />