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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: S50.00 <br /> Survey of Existing Parcel: $50.00/lot <br /> and/or Pre-Application Form or Map Review Form Subdivision w/Survey: $200.00+$50.00not <br /> Owner b <br /> Owner: Joseph Nelson )U": Wilderness Fellowship 9 <br /> C <br /> Address:PO Box 400 Addre s: 21897 Spirit Lake Rd W o <br /> Frederic WI 54837 Frederic WI 54837 <br /> Phone: Phone: <br /> �1 <br /> Original Parcel Information <br /> Tag ID#: 07-034-2-37-18-11-5 05-002-020000 & Section 11 Township 37 Range 18 <br /> 011000 <br /> Original Description(or attach copy): Lt 1 CSM V5 P279 &GL 2&3 ell, <br /> r <br /> a <br /> Current Zoning: A2/RR1 Floodplain Y/N:Y Wetlands Y/N: N Lake/River Class: <br /> 5 � <br /> Name of Water Body:Spirit Lake Shoreland Agreement/SlPS Y/N: y 1 <br /> Farmland Preservation Y/N:N Managed Forestry Law Y/N: N <br /> o <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: 2 Lot CS M � <br /> 0 <br /> y <br /> Acres: <br /> b <br /> y <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> N � <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: W <br /> Signature of Owner: Date: 2r� Z ti W W <br /> J <br /> Signature of Owner: 1A A&LAI&& Date: <br /> ➢ Does parcel meet Zoning Requirements? Yes No Fee Rec: 2—Q7, <br /> Check#: G 1�l <br /> ➢ Does parcel require a Survey? Yes No <br /> Reconciles with Real Property Lister Yes No Date: <br /> If not,explain• <br /> Applicatio proved 1 nied Reason for Denial- <br /> Land Us Date: <br />