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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-ApplicaQhWUUftTER/SCA ®ivisionw/Survev: $200.00+$50.00/lot <br /> Owner: Wesley Graves Buyer: .Tnshua .L T.[]CAS <br /> A <br /> Address: 23878 N. Alpha Drive Address: 105 Birch St. E. <br /> z <br /> Grantsburg, WI 54840 Frederic, WI 54837 <br /> Phone: 715/689-2550 Phone: 715/222-8688 U[J <br /> Original Parcel Information <br /> Parcel ID#: 042-2515-01 200 Section 15 Township 38 Range 18 JU <br /> O <br /> Original Description(or attach copy): NW NE, Sec. 15-38-18, Burnett County, WI. <br /> Current Zoning: OkgdA Floodplain�/N:4--Wetland�'/lY: l Lake/River Class: / <br /> o Name of Water Body: Shoreland Agreement/SIPS Y/N: <br /> 9 <br /> A, Farmland Preservation Y/N: Managed Forestry Law Y/N: p <br /> ' New Parcel Information <br /> Proposed New Legal Description and Parcel Size: 1) NE 1/4 NW 1/4 NE 1/4, Sec. 15-38-18, <br /> Burnett County, WI. 10 acres 2) NW 1/4 NE 1/4 EX NE 1/4 thereof, <br /> Sec. 15-38-18, Burnett County, WI. 30 acres Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: N. Fork Drive O <br /> m <br /> A <br /> Proposed access to public waters to be provided Y/N: "1 <br /> If yes,describe access: <br /> Signature of Owner: Lr�'� Date: -7� <br /> c C7 <br /> Signature of Owner: Date: 9 <br /> UI' ppy} �0 ° <br /> ➢ Does parcel meet Zoning Requirements.? � Na oK 13-/J <br /> " <br /> ➢ Does parcel require a Survey? Yes No <br /> 0 <br /> 00 ➢ Permit application fees submitted? ❑ Amount$ Receipt# <br /> ;11,Reconciles with Real Property Lister es No Date: () <br /> a <br /> � <br /> If not,explain: � <br /> 'a N <br /> y C7 <br /> 6 <br /> ApplicatioApproved Denied Reason for Denial: f'�- 17—/0 <br /> Land Use: Date: / <br />