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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 /> 1-1 ce <br /> b <br /> owner: Melvin &Allyson Medin Buyer: Voyager Village POA 1' 6 <br /> C .. <br /> Address:4513 Silver Birch Traiiway Address: 28851 Kilkare Rd A o <br /> Webster WI 54893 Danbury WI 54830 of 5 <br /> n\ R' <br /> Phone: Phone: U , <br /> �0 <br /> Original Parcel Information p <br /> Tax ID#: 07-012-2-40-15-22-5 15-707-090000, section 22 Township 40N Range 15W <br /> 091000 & 092000 <br /> Original Description(or attach copy): Lots 85-86 & OL 1 Silver Birch Add to W <br /> i <br /> es <br /> ti <br /> Current Zoning: PUD Floodplain Y/N:N Wetlands Y/N: N Lake/River Class: "� <br /> Name of Water Body:NSA 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: CSM A <br /> 11, <br /> '731 a <br /> Acres. d 1 <br /> • <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) y <br /> Proposed access to public road: <br /> 5 <br /> Proposed access to public waters to be provided Y/N: ,t <br /> If yes,describe access: ` V`► <br /> ll °�' G <br /> Signature - Date: J 1'' �rl ^ 7 ul <br /> re of Owe:_ al <br /> Signs a of Owner: N.pr\lkL/N Date i i'' t O - Z <br /> ➢ oes parcel meet Zoning Requi cuts? Yes No Fee Rec: �0,'� <br /> Check#:6/02-g <br /> > es parcel requJe a Survey? Yes No 1 <br /> Reconciles with Real Property Lister Yes No Date: S <br /> Fo <br /> If not,explain: - <br /> 0 <br /> 1 <br /> •e <br /> Application. Approved / enied Reason for Denial• 0 <br /> Land Use.)7 �-, Date: <br /> -� 3o zoZ y <br /> 6 <br />