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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br /> ot <br /> and/or Pre-Application Form Surveybdi sio n Existing/S Parcel: +$5 <br /> Subdivision w/Survey: $200.00+550.00/lot <br /> Owner: Wayne&Rebecca Lake Buyer: b <br /> Address: 12975 North Rd Address: <br /> Grantsburg WI 54840 c <br /> • <br /> Phone: Phone: <br /> G Original Parcel Information g <br /> Parcel ID#: 07-042-2-38-18-18-1 03-000-011000 Section 18 Township 38N Range 18W J <br /> O <br /> Original Description(or attach copy): SW-NE ex CSM V12 P185 <br /> 1A <br /> y A2/unzone N Y <br /> .d Current Zoning: oodpiain YIN: Wetlands Y/N: Lake/River Class: <br /> .,:s <br /> ao Name of Water Body: N/A Shoreland Agreement/SIPS Y/N; .S <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N: N <br /> New Parcel InformationZ. <br /> Proposed New Legal Description and Parcel Size: CSM <br /> r <br /> Acres: P <br /> 7 ' <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) 16 <br /> Proposed access to public road: C <br /> ao <br /> Proposed access to public waters to be provided Y/N: •`D•� <br /> ._\ <br /> If yes,describe access: <br /> ki <br /> Signature of Owner. O)z4�i Date: 0. -)7 R0.2R. Q <br /> Gi <br /> Signature of Owner: <br /> Alaef. cam\ t5:1-4,14 Date: Volt / / c 2 <br /> / 'o <br /> ➢ Does parcel meet Zoning Requirements? Yes No _ l/#&2 8"5 2— a <br /> �" -s <br /> > Does parcel require a Survey? Yes No <br /> I pO W <br /> Permit application fees submitted? 0 Amount$ �32511 Receipt# ir <br /> is <br /> W <br /> t' 0 Reconciles with Real Property Lister es No Date: OCI I i S-130D 3 <br /> a <br /> 0. If not,explain: 6 �'1� <br /> ea uJ o <br /> 0 <br /> o. <br /> 'tom <br /> Applies ' . Approved / nied Reason for Denial: <br />