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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+$50.00/lot <br /> Owner: Duane Hoefs Buyer: b <br /> Address: 23326 Wood Creek Road Address: <br /> Siren, WI 54872 z <br /> 0 <br /> I'l,one: 715-205-7532 Phone: <br /> I <br /> Oriainal Parcel Information <br /> Parcel ID#: 006-2423-02100 Section 23 Township 38N Range 1 7 VV �Q <br /> Original Description(or attach copy). The NWI/a-SW°/a O <br /> Current Zoning: A-2 Floodplain Y/N: N Wetlands YIN: N Lake/River Class: N/A � <br /> a Name of Water Body: Shoreland Agreement/SIPS YIN; <br /> Farmland Preservation Y/N: N Managed Forestry Law YIN: N <br /> OV1 <br /> New Parcel Information <br /> Vo a�o Po J <br /> Proposed New Legal Description and Parcel Size: A two lot CSM will be done to divide this <br /> property into two lots. One will be 5 acres and one will be 34.6 acres. This is <br /> allowed in the A-2 district by Density Development. Acres: 39.6 acres <br /> (if parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: Direct Access to Wood Creek Road p <br /> Proposed access to public waters to be provided Y/N: N r <br /> If yes,describe access: Ile <br /> / W <br /> Signature of Owner: Date: <br /> Signature of Owner: Date: o <br /> 8 <br /> e <br /> ➢ Does parcel meet Zoning Requirements? Yes No A <br /> �s <br /> xe <br /> 9e ➢ Does parcel require a Survey? Yes No <br /> 0 <br /> 00 D Permit application fees submitted? Amount$ Receipt# <br /> r• ❑ Reconciles with Real Property Lister Yes No Date: <br /> d <br /> 0 <br /> °' If not,explain: <br /> n <br /> 0 <br /> a <br /> Vi <br /> Application• Approved / Denied Reason for Denial: UG <br /> (-Ulu jWj <br /> Pe44 V o 60 7' -TT 60UNU <br /> w11NS, <br /> Land Use: Date: B -rn <br />