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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 /> 0.4 ►o <br /> Owner: Rodney Wilson Buyer: el g <br /> T <br /> Address: 13793 State Rd 35 S Address: et 0 <br /> Danbury WI 54830 <br /> N <br /> Phone: Phone: `I'' <br /> Orizinal Parcel Information <br /> Tax ID#: 07-032-2-41-16-28-5 15-016-03100-Q, Section 28 Township 41 N Range 16W <br /> 032000, 033000 <br /> Original Description(or attach copy): <br /> Lots 7-9 Block 9 AM Brooks 1st Addition O <br /> 4 <br /> a <br /> A <br /> Current Zoning: RR1 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 <br /> New Parcel Information <br /> ` Proposed New Legal Description and Parcel Size: CSM ` <br /> r` <br /> II <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) .,l <br /> Proposed access to public road: k <br /> El, <br /> Proposed access to public waters to be provided Y/N: <br /> C>J <br /> If yes,describe access: r <br /> (2....41t_ar,Okkitc.‘N..." Ni NE ') <br /> 44 <br /> Fee Rec: <br /> > Does parcel meet Zoning Requirements? Yes No Check#: <br /> > Does parcel require a Survey? Yes No ftt,N/" <br /> G7 <br /> Reconciles with Real Property Lister es No Date: co(ani ` <br /> If not,explain: <br /> Application: pproved / Hied Reason for Denial. <br /> Land Us Date: <br /> ee yv ck Ih?ce'T/ 4 �c `l" 2 �� <br />