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-i <br /> Address: 22950 County Road Y Address: 2062 122 Ave <br /> z <br /> Grantsburg, Wi 54840 _St Croix Falls, WI 54024� <br /> Phone: 651 -248-1396 Phone: 71 ':-4' 1-1927 <br /> Original Parcel Information <br /> 4 pomels (continued below) <br /> Parcel ID#: Tox ID: 29483 PIN: 07-042-2-38-18-27-5 15-209-037000 Section 27&28 Township__38 ___ Range 18 _ <br /> — o <br /> Original Description(or attach copy): All of Lots 1,2,3&4 CSM V19 P213 (y360155) <br /> Tox ID: 29484 PIN: 07-042-2-38-18-27-5 15-209-038000 <br /> Tax ID: 29485 PIN: 07-042-2-38-18-27-5 15-209-039000 Being port of Gov't Lot 4 of Sec. 27 <br /> Tox ID: 29486 PIN: 07-042-2-38-18-27-5 15-209-040000 <br /> & part of Gov't Lot 1 of Sec. 28 <br /> Current Zoning: RR1 Floodplain Y/N: Wetlands Y/N: <br /> Lake/River Classification: Name of Water Body: (6i9) Wood Lake <br /> Shoreland Agreemt or SIPS Y/N:_ —Farmland Preservation Y/N: Managed Forestry Law Y/N: <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: Proposed CSM <br /> Acres: 4.4 t <br /> (if parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: County Road Y (via existing common drive) p <br /> m <br /> Proposed access to public waters to be provided Y/N: No <br /> If ves, describe access: <br /> Signature of Owner: Date: <br /> �. <br /> Signature of Owner- Date: /��'12— 7X L41 n 0 <br /> 3 <br /> Does parcel meet Zoning Requirements? yes 1V0 <br /> Does parcel require a Survey? yes No <br /> i Permit application ftes submitted? 0 Amount g _ _ Receipt# <br /> 0 Reconciles with Real Property Lister Yes No Date: <br /> If not,explain: <br /> Application: Approved / Denied Reason for Denial: <br />