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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 Subdivision w/Survev: $200.00+$50.00/lot <br /> Owner: Douglas and Laura Coyour Buyer: Mitchell and Kelsie Coyour <br /> Address:22501 Coyour Road Address: 5400 Town Line Road @. <br /> Frederic, WI 54837 Frederic, WI 54837 <br /> Phone: 715 653 2695 Phone: 7155 222 5999 <br /> Orieinal Parcel Information <br /> part of 07-014-2-38-15-31-4 04-000-011000 <br /> Parcel ID#: „+ ofm_nt n_2_U_t 9-21_n nt_nnn_6f1 TownshipRN Rangel;7,1,1 <br /> O <br /> Original Description(or attach copy): See Tax Statements <br /> A <br /> d <br /> o Current Zoningttn7nned Floodplain Y/N:_L_Wetlands Y/N: N Lake/River Class: <br /> Name of Water Body: Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation Y/N: Managed Forestry Law Y/N: <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: See Attachment <br /> Acres: 20 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: over easement to 360th Ave. o <br /> m <br /> Proposed access to public waters to be provided Y/N: N <br /> If yes,describe access: <br /> Signature of Owner: Date: <br /> Signature of Owner: Date: <br /> C <br /> )o Does parcel meet Zoning Requirements? Yes No , <br /> e ➢ Does parcel require a Survey? Yes _� <br /> ➢ P /fin <br /> it a <br /> 00 e lication ees submitted? Amount$ -j�J V"1 0 / <br /> pp f � Receipt# <br /> C. Reconciles with Real Property Lister Yes No Date: <br /> m <br /> 0 <br /> 77 <br /> If not,explain: <br /> 0 <br /> a <br /> Applicatio Approved / enied Reason for Denial: LiAV -1 <br /> Land UDate: BURNETT COUNTY <br /> ZONING <br />