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Fees(must accomp y form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Surrey: $50.00 <br /> Survey of Existing arcel: $50.00/lot <br /> and/or Pre-Application Form or Map Review Form Subdivisionw/Su ey: $200.00+$50.00not <br /> Owner: Ronald Pagenkopf g i <br /> Buyer: �, <br /> Address: 28850 Wilderness Circle Address: d c <br /> Danbury WI 54830 <br /> X cO, <br /> Phone: <br /> Phone: w <br /> I <br /> Original Parcel Information <br /> 07-012-2-40-15-10-5 15-85/-041000 <br /> Tax ID#:)47lnCL 04. 00ft 044000 Section 10 Township 40N Range 15W <br /> Original Description(or attach copy): Wilderness Trail Add to VV Lots 31-34 <br /> 0 <br /> a <br /> 0 <br /> P U D <br /> Current Zoning: Floodplain Y/N:N Wetlands Y/N: N Lake/River Class: <br /> Name of Water Body: N/A Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N: N Q <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: CSM combine 4 existing lots <br /> Acres: I <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: , <br /> Proposed access to public waters to be provided Y/N: <br /> NI <br /> If yes,describe access: .�.p , <br /> �/ <br /> > Does parcel meet Zoning Requirements? Yes No Fee Rec: <br /> Check#: <br /> > Does parcel require a Survey? Yes No <br /> Reconciles with Real Property Lister Yes No Date: n{ 0.(a3,--13 <br /> If not,explain: <br /> Application Approved Hied Reason for Denial- <br /> 4,,, <br /> Land Use: Date: <br /> ,.-4„...4...-e.-- CP/Y/?-46 aj__________ . <br />