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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+$50.00/lot <br /> Owner: Kevin & Joan Duncan Buyer: .0 <br /> et <br /> Address: PO Box 271 Address: 3 <br /> 2 <br /> Frederic, WI 54837 °t.b <br /> C <br /> Phone: 715—56 6—0056 Phone: CA <br /> Original Parcel Information <br /> 5 parcels (continued below) t <br /> Parcel ID#: Tax ID: 28838 PIN: 07-042-2-38-18-21-2 01-000-013000 Section 21 Township 38 Range 1 8 <br /> OkA <br /> Original Description(or attach copy): Part of the NE1/4—NW1/4, a <br /> Tax ID: 28839 PIN: 07-042-2-38-18-21-2 01-000-014000ft1 <br /> Tax ID: 28846 PIN: 07-042-2-38-18-21-2 04-000-012000 Part of the SE1/4—NW1/4, <br /> Tox ID: 28845 PIN: 07-042-2-38-18-21-2 04-000-013000 (per <br /> �v Tox ID: 28847 PIN: 07-042-2-38-18-21-3 01-000-011000 & all of the NE1/4—SW1/4, <br /> m Current Zoning: Unzoned /4^� Floodplain YIN: Wetlands Y/N: Ye- 4,6, <br /> Lake/River Classification: N/19 Name of Water Body: <br /> Shoreland Agreemt or SIPS Y/N: Farmland Preservation YIN: Managed ForestryLaw YIN: <br /> g g <br /> New Parcel Informationrr, <br /> Proposed New Legal Description and Parcel Size: Proposed CSM <br /> (No new lots — Rearrangement of existing 5 parcels) J <br /> Acres: 98 Ac.± <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: State Road 70 (shared common access via easement) C7 <br /> to <br /> R <br /> Proposed access to public waters to be provided N: 'i <br /> Y/ <br /> If yes,describe access: 6 � <br /> /� ` l2 <br /> Signature of Owner: ,1 -v-'1�� Date: �!3/23 <br /> Signature of Owner. + Dv w��w Date: I a l A/c?3 <br /> b <br /> ➢ Does parcel meet Zoning Requirements? Yes No '6Q,°% AO"4.,ik 2022, g. <br /> N 9 <br /> o xt <br /> B ➢ Does parcel require a Survey? Yes No [ � n <br /> aro D o c4 Z Z I c0 <br /> ➢ Permit application fees submitted? ❑ Amount$ Y,O, Receipt# °Q �0 <br /> 'k• <br /> ,r, 0 Reconciles with Real Property Lister Yes No Date: =r‘ N <br /> o <br /> a h.) <br /> If not,explain: <br /> o <br /> FA. V l" <br /> Application: Approve I Denied Reason for Denial: <br /> g ti,_Aglly t,,„2..t,ea� .. ��ted 4 Z : 5,,„y &n5)'fy D cyMC,►%+-- Pyk,0'5, -6r <br /> Land Use: �i �/6 �Z/ Date: h^Z' amts. <br /> 2 see 00 oh csio cit 54 a jpou71" rock,/ �Y'at j77ONq/ �Di-f <br /> D � <br />