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Fees(mu: ac�ujnpa;y 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+$50.00/lot <br /> Owner: Victory Fireworks, Inc. Buyer: b <br /> Address: P.O. Box 268 Address: 9 <br /> Ellsworth, WI 54011 0 <br /> Phone: 715-684-9504 Phone: <br /> Original Parcel Information Y) <br /> y <br /> Parcel ID#: 032532702200 /032532702100 Section 27 Township 41 N Range 16W (� <br /> Original Description(or attach copy). Lots 1 & 2, CSM V.23, p.6-8 <br /> A <br /> t <br /> > C-1 N N - <br /> Current Zoning: Floodplain Y/N: Wetlands Y/N: Lake/River Class. Z <br /> Name of Water Body: Shoreland Agreement/SIPS Y/N: <br /> T Farmland Preservation Y/N: N Managed Forestry Law Y/N: N <br /> New Parcel Informaatioon, <br /> Proposed New Legal Description and Parcel Size:— ns 1 I�,, ,)E e <br /> This CSM changes the boundary between Lots 1 and 2. TTT <br /> Acres: 1.73 / 7.74 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: As Shown <br /> v <br /> m <br /> Proposed access to public waters to be provided Y/N: N A <br /> �L <br /> If yes,describe access: c1j <br /> Signature of Owner: N/A Date: <br /> Signature of Owner: Date: o <br /> a <br /> b <br /> ➢ Does parcel meet Zoning Requirements? Yes No A <br /> ➢ Does parcel require a Survey? Yes No <br /> Permit application fees submitted? ❑ Amount$ ' o Receipt# <br /> r- ❑ Reconciles with Real Property Lister Yes No Date: <br /> m <br /> n If not,explain: <br /> x <br /> n <br /> n <br /> O <br /> Z <br /> 6 <br /> Application: <&proved / enied Reason for Denial: <br /> Land Use: Date: Z7 �� <br />