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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subd visionw/o Survey: $50.00 <br /> Survey of Existing Parcel: $50.00/IOt <br /> and/or Pre-Application Form Subdivision w/Survey: $200.00+$50.0011ot <br /> Duane L. Hazelton Revocable Trust - 112 int. <br /> Owner: Michael Swatzi na - 1 1 4 int. Buyer: <br /> Christopher awn amine J. swatzina 114 int. <br /> Address:7243 Hayden Lake Road Address: <br /> x <br /> Danbury, WI 54830 �? <br /> Phone: (715) 656-3552 Phone: <br /> Orieinal Parcel Information <br /> 07-020-2-40-16-09-1 02-000-012000 <br /> Parcel ID#: Section 09 Township 40N Range 16W p <br /> Original Description(or attach copy): That part of the NW 114 NE 114, Sec. 9. T40N <br /> R16W, lying Snuth of rpntprlinp of Hayrlpn laky Rnad, Rurnatt rn�-- WT• <br /> Current Zoning: RR-3 Floodplain Y/N: N Wetlands Y/N: N <br /> Lakelitiver Classification: n a Name of Water Body: n I a <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: See attached. <br /> two Pell cels each <br /> Acres: 17.65 in size <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: Hayden Lake Road <br /> d <br /> Proposed access to public waters to be provided Y/N: N A <br /> If yes, describe access: <br /> i <br /> Signature of Own • / Date: August 2011 <br /> o Duane L. az tTrustee <br /> 0° Signature of Owner: Date: e <br /> e <br /> 9 <br /> ➢ Does parcel meet Zoning Requirements? Yes No A <br /> u <br /> e ➢ Does parcel require a Survey? Yes No 0 <br /> a J <br /> D Permit application fees submitted? ❑ Amount$,5D 0 O Receipt# <br /> e Q <br /> w I;(Reconciles with Real Property Lister Yes / No Date: <br /> L <br /> s <br /> If not,explain: <br /> T <br /> 0 <br /> Application: Approved / enied Reason for Denial: <br /> Id <br /> 0 <br /> -3-�/ <br /> Land Use: Date: o <br /> c <br /> 0 <br />