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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 or Map Review Form Subdivisionw/Survey: $200.00+$50.00/lot <br /> ., b <br /> Le fo <br /> Owner: Jon &Wendy Byl Buyer: A P. <br /> d <br /> Address: 1094 145th Ave Address: o <br /> New Richmond WI 54017 ,-4 u) <br /> Phone: Phone: A <br /> Original Parcel Information Z <br /> Tag ID#: 07-012-2-40-15-11-5 15-725-021000 Section 11 Township 40N Range 15W �' <br /> 07-012-2-40-15-11-5 15-725-022000 0 <br /> Original Description(or attach copy): Lts 11-12 Tall Moon Add to W g <br /> iii <br /> i 9 <br /> Current Zoning: PUD Floodplain Y/N_N Wetlands YIN: N Lake/River Class. <br /> Name of Water Body: Shoreland Agreement/SIPS YIN: zc- <br /> Farmland Preservation Y/N:N Managed Forestry Law Y/N: N <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.) <br /> Proposed access to public road: C <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: <br /> VA <br /> '11' ' : & $CI:': T• : 5-as -ail <br /> :y. , <br /> -Fee Rec.-'''"- <br /> ➢ Does parcel meet Zoning Requir ments? Yes No ��d <br /> Check#: <br /> ➢ Does parcel require a Survey? Yes No .0198- <br /> Reconciles with Real Property Lister Yes No Date: <br /> If not,explain: <br /> Application. •pproved / P enied Reason for Denial. <br /> Land Use: / Date: <br /> 1 /zeZ7 <br />