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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/tot <br /> and/or Pre-Application Form or Map Review Form Subdivision w/Survey: S200.00+$50.00/lot <br /> Merkavah Zellmer <br /> Owner: Buyer: <br /> Address: 14688 Oeltjen Rd Address: <br /> Grantsburg WI 54840 <br /> Phone: Phone: <br /> Original Parcel Information UJ <br /> Tax ID#: 07-002-237-19-32-1 01-000-012000 Section 32 Township 37N Range 19W <br /> Original Description(or attach copy):Lot 1 CSM V23 P307 <br /> a <br /> Current Zoning: RR3 Floodpiain Y/N_Y Wetlands Y/N: Lake/River Class: <br /> Name of Water Body:NIA Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation YIN:N Managed Forestry Law Y/N: N <br /> 3-- <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: 2 lot CSM <br /> Acres* <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> Proposed access to public waters to be provided Y/N: ?' <br /> If yes,describe access: <br /> Signature of Owner: &( — Date: — 3 <br /> , <br /> Signature of Owner: �'4n' 4', (llhI/'( Z Date: ( Z <br /> v� <br /> > Does parcel meet Zoning Requirements? Yes No Fee Rec: 3re' <br /> cA Check#: <br /> > Does parcel require a Survey? Yes No <br /> Reconciles with Real Property Lister Yes No Date: <br /> If not,explain: <br /> 0 <br />