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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision who Survey: $50.00 <br /> Survey of Existing Parcel: $50.00/lot <br /> and/or Pre-Application Form or Map Review Form Subdivision w/Survey: $200.00+$50.00/lot <br /> .0 b <br /> CA <br /> Owner: John & Stephanie Meierhofer Migiblt-ir160- (\ni2=63r^1 "I- 3(-)"(-) ei g <br /> La`'�-I�n g T <br /> Address:28646 Great Bear Pass ,.., I33• (,vv ,v id 2' o <br /> Danbury WI 54830 L`,no ,0,1,.,e- i i'\) 5564 [ <br /> \ to <br /> Phone: t5)' g''"Vram, I)l J Phone: la- ,-"a--I s 7 'i'^r• <br /> R> <br /> Original Parcel Information ID <br /> Tax ID#: 07-012-2-40-15-13-5 15-255-076000 Section 13 Township 40N Range 15W <br /> 07-012-2-40-15-13-5 15-255-075000 <br /> Original Description(or attach copy): Great Bear Add to W Lots 65-66 <br /> 5 <br /> 0 <br /> Current Zoning: PUD Floodplain Y/N:N Wetlands Y/N: N Lake/River Class. <br /> Name of Water Body:N/A Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation Y/N:N Managed Forestry Law Y/N: N <br /> l <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: CSM to combine 2 existing lots <br /> Acres. <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) ,.g <br /> a <br /> Proposed access to public road: <br /> 1�...y1 <br /> V <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe acces . e X. <br /> Signature of;0viex: �� 7 Date: j I S-262,c7 p C <br /> Bu er V-644 PI A- I\I ar1-tv, . ) 15/1"PILf <br /> dd <br /> .3. Fee Rec: 5i --' <br /> ➢ Does parcel meet Zoning Requirements? Yes No = Check#:(p O 7 <br /> > Does parcel require a Survey? Yes No m <br /> I <br /> Reconciles with Real Property Lister Yes No Date: <br /> rn.. <br /> v= <br /> If not,explain: <br /> a <br /> E <br /> Applicatio . Approved / enied Reason for Denial. o <br /> Land Us • C- Date: << <br />