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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 Subdivision w/Survey: $200.00+$50.00/lot <br /> Owner: Scott&Kelly Caroon Buyer: b <br /> eD <br /> Address: 332 N Washington St Address: l <br /> ; <br /> St Croix Falls WI 54024 z <br /> 0 <br /> 651-775-4297 <br /> Phone: Phone: 13) <br /> Original Parcel Information CM <br /> 07-040-2-39-18-01-1 04-000-012000 <br /> Parcel ID#: 07-040-2-39-18-01-1 04-000-011000 Section 01 Township 39N Range 18W <br /> dO <br /> Original Description(or attach copy): N 330'SE-NE <br /> eD <br /> VI <br /> 7 <br /> 0 <br /> .o Current Zoning: RR3 Floodplain Y/N: N Wetlands Y/N: N Lake/River Class: <br /> m .ram <br /> RName of Water Body: N/A Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N: N ....._ <br /> New Parcel Information (• <br /> Proposed New Legal Description and Parcel Size: CSM combine lots <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: C7 <br /> w <br /> Proposed access to public waters to be provided Y/N: et <br /> If yes,describe access: y <br /> .E Scott Caroon ;; . 08/30/2022 N <br /> ... <br /> V., <br /> Signature of Owner: Date: o <br /> 3 <br /> � �, mat <br /> ➢ Does parcel meet Zoning Requirements? Yes No �^ 6o 8'. ", A <br /> ➢ Does parcel require a Survey? Yes No <br /> 0° ➢ Permit application fees submitted? 0 Amount$ 7�� Receipt# <br /> i0 Reconciles with Real Property Lister No Date: (1 1'1 ZOZ3 <br /> o it <br /> If not,explain: <br /> 0 <br /> V <br /> y ki <br /> Applicati . Approv / Denied Reason for Denial: <br /> Land Use: /L�-�� /0 7 zO 2-_,3 Date: <br />