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. Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br /> and/or Pre-A lication Form Survey of Existing Parcel: $50.00/lot <br /> PP Subdivision w/Survey: $200.00+$50.00/lot <br /> Owner: Michael G. & Deborah K. Tighe Buyer: Eric R. and Jessica J. Burton <br /> 10185 State Rd 70 Address: 408 West Cook St. <br /> Address: g. <br /> Siren, WI 54872 <br /> New London. WI 54961 <br /> 715-689-2229 707-899-7229 c <br /> Phone: Phone: 9 <br /> Original Parcel Information f1,� <br /> Parcel ID#: 07-006-2-38-17-20-2 02-000-011000 Section 20 Township 38 Range 17o <br /> GT1 <br /> Original Description(or attach copy): NW NW lying South of Hwy except Hwy <br /> n <br /> g\ <br /> Current Zoning: Floodplain Y/N: Y Wetlands Y/N: Y Lake/River Class: N 41^ <br /> �c <br /> Name of Water Body: Shoreland Agreement/SIPS Y/N: a <br /> Farmland Preservation Y/N: <br /> Managed Forestry Law V/N: ' 11s <br /> (1 <br /> New Parcel Information <br /> The South 380 feet of the NW NW, Section <br /> Proposed New Legal Descri tion and Parcel Size: <br /> 20, Township 38 North, Range 17 West. <br /> V <br /> Acres: 11.5 R. R- <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Kempf Road <br /> Proposed access to public road: <br /> .0 <br /> Proposed access to public waters to be provided Y/N: N <br /> N If yes,describe access: <br /> .� <br /> Signature of Owner: //( ,1-0 Ad,/ Date: ,42-1///a3 NG <br /> Signature of Owner: 4, ly Date: ,` 2--— 1 ( — 3 0 <br /> 3 <br /> > Does parcel meet Zoning Requirements? Yes No , <br /> e> <br /> N <br /> G > Does parcel require a Survey? Yes NoE C E J ..o <br /> E. V, <br /> � fees> Permit application submitted? 0 Amount$ 5� Receipt# Z d i{,Z� <br /> 0 Reconciles with Real Property Lister No Date: t D. ci °kat', <br /> °' If not,explain: Burnett County <br /> Land Services Dcpartmont <br /> 0 <br /> a <br /> y <br /> Application: cproved / enied Reason for Denial: <br /> Land Use: Date: Oe 7.Oz3 <br />