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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> Subdivision wt°Survey: $10.00 <br /> and/or Pre-Application Form <br /> Subdivision w/Survey:$100.00+$15.00not <br /> Owner: Randy R. & Carol Soderbeck <br /> Address: 24869 Soderbeck Rd. A <br /> Grantsburg , WI 54840 @. <br /> Phone: 715/463-2419 <br /> 0 <br /> Original Parcel Information �j y <br /> Parcel Identification#: 040-3632-02 400 32 <br /> Section Township 39N Range 19W `� „• <br /> Original Description(or attach co E i SE1-4 SWI-, <br /> O <br /> 0 <br /> A <br /> Current Zoning: Floodplain Y/N: N Wetlands Y/N: N 4 <br /> o° Lake/River Classification: N/A Name of Water Body: N/A <br /> C <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: SE3, of SEi, SW; (10 Acres) <br /> NE; of SE; SW; (10 Acres ) <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) (� <br /> Proposed access to public road: Soderbeck Road <br /> Proposed access to public waters to be provided Y/N: N <br /> If yes, describe access: <br /> d <br /> m <br /> Signature of Owner: �i�vr„L J7 , p 1Cn W Date :l /'S 6c 7 <br /> 47 <br /> S ➢ Does parcel meet Zoning Requirements? yes Aro J <br /> Does parcel require a Survey? yesNo <br /> J <br /> /� �,7 <br /> Permit application fees submitted? ❑ Amount$ /V' (�Q Receipt# "/ <br /> e <br /> r <br /> V <br /> ❑ Reconciles with Real Property Lister Yes Date:_ V 07 <br /> If not,explain: `O/Y\ <br /> o r <br /> (A nlM o rA Irv, n MT 1 <br /> 1� <br /> Application: Approved / Denied Reason for Denial: SU <br /> Land Use: Date: <br /> C7 <br />