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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+$50.00/lot <br /> Michael E. Tighe and The Melford E. Trone and Patricia <br /> Owner: Vicki J. Tighe Buyer: J. Trone Revocable Living Trust b <br /> Address: 5126 County Road C Address: 5026 County Road C 3 <br /> R <br /> z <br /> Danbury, WI 54830 Danbury, WI 54830 <br /> Phone: 715-866-8853 Phone: 715-866-8693 <br /> Original Parcel Information <br /> Parcel ID#: 07-012-2-40-15-08-4 04-000-012000 Section�_Township 40N Range ]5W <br /> O <br /> Original Description(or attach copy): See attached rider. <br /> �e <br /> ,> Current Zoning: A2 Floodplain Y/N: NO Wetlands Y/N: NO Lake/River Class: NO <br /> v <br /> m Name of Water Body: Shoreland Agreement/SIPS Y/N: NO <br /> 0 <br /> Farmland Preservation Y/N: NO Managed Forestry Law Y/N: NO <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: See attached rider. <br /> Acres: 3 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: County Road C d <br /> Proposed access to public waters to be provided Y/N: NO <br /> If yes, describe access: w <br /> Signature of Owner. Date: <br /> �- 2-d/(o <br /> Kc 6 1 <br /> / <br /> Signature of Owner: Date: o 0 <br /> Vicki J Tiahe V <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> t <br /> c ➢ Does parcel require a Survey? Yes No O h <br /> o J <br /> o Q <br /> 0° ➢ Permit application fees submitted? Amount$_5Z e ren Receipt# d <br /> Reconciles with Real Pro erty Lister Yes Date: /0 <br /> o <br /> � If not,explain: <br /> ���2hti JeQvlJ7�rJ�f�Gt�,/� n°.�1zMUM <br /> Applicatio Approved / benied Reason for Denial: ' <br /> Land use: - / /z ��lv Date: BURNETT COUNTY <br />