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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br /> and/or Pre-Application Form Subveysionof w Surverce$: 0.0.00/lot <br /> Subdivisionw/Survey: $200.00+$SO.00Aot <br /> Owner: Dale E. Petersen Buyer: Harold and Dianne McCann y <br /> Address: 1137 West Point Road Address: 10591 Penfield Ave, Circle N. 3. <br /> z <br /> Spooner, WI 54801 Stillwater, MN 55082 <br /> Phone: (715) 635-8594 Phone: (651) 439-4987 <br /> Orisinal Parcel Information <br /> Parcel ID#: 07-028-2-40-14-25-5 05-002-027000 Section 25 Township 40N Range 14W <br /> O <br /> Original Description (or attach copy): SEE ATTACHED <br /> n m <br /> ya Current Zoning: r Floodplain Y/N: N Wetlands YIN: N Lake/River Class: <br /> Name of Water Body: Shoreland Agreement/SIPS Y/N: N <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N: N U <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: SEE ATTACHED <br /> Acres: 6.2 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: Hill Road tv <br /> m <br /> Proposed access to public waters to be provided YIN: N t <br /> If yes, describe access: <br /> Signature of Owner: Date. <br /> Dale E. Petersen � <br /> Signature of Owner: Date: 3 <br /> C <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> ➢ Does parcel require a Survey? Yes No ry <br /> V <br /> PO ➢ Permit application fees submitted? Amount S Receipt# <br /> S <br /> Go <br /> r. ❑ Reconciles with Real Property Lister Yes No Date: rte ^ <br /> y Y <br /> If not,explain: �. 1 <br /> n Su <br /> o SO <br /> z <br /> VI <br /> Applicata Approved Denied Reason for Denial: <br /> I� <br /> S <br /> Land Use: Date: <br /> / c <br />