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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.cwnot <br /> G Iv <br /> lb <br /> Owner: John & Michelle Mortel Revoc Living t& M & M Storage Inc co <br /> 3 <br /> i' <br /> d <br /> Address:3929 W Deer Lake Rd Address: ii <br /> Danbury WI 54830 r [� <br /> Phone: Phone: A <br /> R co <br /> Original Parcel Information <br /> Tax ID#: 07-032-2-41-15-12-5 05-003-018100 Section 12 Township 41 Range 15 C <br /> 07-032-2-41-15-12-5 05-003-01/TOU o <br /> Original Description(or attach copy): Lot 28 &29 CSM#4799 V26 P318 a <br /> nr <br /> 3 <br /> Current Zoning:RR1/RR3 Floodplain YIN:Y Wetlands Y/N:N Lake/River Class: KA <br /> y.Deer LakeAgreement/SIPSn <br /> Name of Water Body: Shoreland Y/N: a i ii <br /> 02 <br /> -r <br /> Farmland Preservation YIN:N Managed Forestry Law YIN: N 3 <br /> ci <br /> New Parcel Information 6' <br /> z <br /> 2 Lot CSM of existing parcels <br /> Proposed New Legal Description and Parcel Size: <br /> m <br /> €t <br /> co <br /> 3. <br /> Acres- <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: E <br /> Oa <br /> W Proposed access to public waters to be provided YIN: 4 6` Tvly <br /> If yes,describe access: <br /> $ignaturefirgMlner: '-c.±4 Date: Co — !3 -•as y v i <br /> Signatu pf(Slaw: r�r'��v. � �� DOM -1. - rGb2 <br /> Fee Rec: /0=2-60 <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> Check#: eo/0 Z2- <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 ed Reason for Denial: <br /> Land e: — Date: <br />