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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 Subdivision w/Survey: $200.00+$50.00/lot <br /> 17, <br /> b <br /> ce el, <br /> Owner: John & Michelle Model Revoc Living Ay,*& M & M Storage Inc g i <br /> d <br /> Address:3929 W Deer Lake Rd Address: 117 o <br /> Danbury WI 54830 00 [ <br /> 7 <br /> Phone: Phone: A <br /> e 1,;),0 <br /> Oriiinal Parcel Information <br /> 1 <br /> Tax ID#: 07-032-2-41-15-12-5 05-003-018100 Section 12 Township 41 ea ge 15 G <br /> 07-032-2-41-15-12-5 05-003-017100 <br /> Original Description(or attach copy): Lot 28 &29 CSM#4799 V26 P318 A <br /> ,RR1/RR3 :Y �.N <br /> Current Zoning: F7oodptain Y/N. Wetlands Y/N: Lahe/River Class: <br /> ch <br /> Name of Water Body:Deer Lake Shoreland Agreement/SIPS YIN: I i • <br /> Farmland Preservation Y/N:N Managed Forestry Law Y/N: N P <br /> New Parcel Information C. <br /> 4g <br /> 2 Lot CSM of existing parcels <br /> Proposed New Legal Description and Parcel Size: <br /> Acres- <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: 5 <br /> Proposed access to public waters to be provided Y/N: W W <br /> If yes,describe access: <br /> re -- aQ �` vi <br /> 59g�at '� Dot fD— 1'3 -�3�a�'-1 <br /> Fee Rec: /C •6)1 <br /> ➢ Does parcel meet Zoning Requirements? Yes No Check#: /o 22 <br /> ➢ Does parcel require a Survey? Yes No <br /> Reconciles with Real Property Lister Yes No Date: <br /> If not,explain: <br /> Applicatio Approved / De led Reason for Denial. <br /> Land e: — J Date: <br />