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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 /> andlor Pre-Application Form or Map Review Form Subdivision w/Survey: $200.00+$50.00/lot <br /> b <br /> WI et, <br /> Owner: Ted & Kelly Gerber Buyer: g g <br /> r <br /> 117 Box PO <br /> Address: Address: on c <br /> Siren WI 54872 c, <br /> F <br /> Phone: 715-431-0041 Phone: W, <br /> Original Parcel Information <br /> Tax ID#: 07-030-2-38-16-09-2 02-000-012000 Section 08/09 Township 38N Range 16W <br /> 07-030-2-38-16-05-5 05-005-016010 <br /> Original Description(or attach copy): <br /> N 848'NW-NW&Outlot 1 CSM V26 P124 GL5 O <br /> 1 <br /> 0 <br /> co <br /> k. <br /> Current Zoning: RR1/A2 Floodplain Y/N:Y Wetlands Y/N: Y Lake/River Class. <br /> Name of Water Body:Crooked Lake 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: 2 lot CSM <br /> Z' <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) .-3 <br /> Proposed access to public road: k <br /> C <br /> Proposed access to public waters to be provided Y/N: <br /> ktik <br /> If yes,describe access: <br /> Signature of Owner: Date: s/ 46Y 3 <br /> Signature of Owner: Date: <br /> 42 <br /> > Does parcel meet Zoning Requirements? Yes No Fee Rec:?j00.°�- <br /> w Check#:6 o?7,f <br /> > Does parcel require a Survey? Yes No c <br /> 6 <br /> xt <br /> Reconciles with Real Property Lister Yes No Date: < <br /> If not,explain: "i <br />