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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: $50.00Aot <br /> and/or Pre-Application Form Subdivision w/Survev: $200.00+$50.00/lot <br /> Owner: Kenneth E. Hayes Buyer: Kenneth J. Hayes <br /> Address: 30151 Minerva Damn Rd, Box 65 Address: 2639 Grand Ave. NE 3 <br /> z <br /> Danbury, WI 54830 Minneapolis, MN 55418 <br /> Phone: 715/656-3702 Phone: 612/706-0572 <br /> 4-, <br /> Orieinal Parcel Information �N <br /> Parcel ID ft: 07-032.-2-41-16-35-2 01-000-019000 Section 35 Township 41 Range 16 <br /> O <br /> Original Description(or attach copy): NE NW EX W 660' , Sec. 35-41-16, Burnett County, <br /> A <br /> WI. <br /> Current Zoning: �&_33 Floodplain /N: Wetlands Y/N: Lake/River Class: <br /> 9 Name of Water Body: J - /"T Shoreland Agreement/SIPS Y <br /> 9 <br /> m Farmland Preservation Y Managed Forestry Law Y/N: <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size:1. NE 1/4 NW 1/4 EX W 990' thereof, <br /> Sec. 35-41-16, Burnett County, WI. 10 acres. 2. E 330' of the W 990' , <br /> Sec. 35-41-16, Burnett County, WI. 10 acres. Acres: <br /> (If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: Flowage Road p <br /> m <br /> Proposed access to public waters to be provided Y/N: N <br /> If yes,describe access: 41� <br /> Signature of Owner: L/ Date: S_`";� S —l U C <br /> Signature of Owner: Date: e <br /> 3 <br /> _ 9 <br /> ➢ Does parcel meet Zoning Requirements? Yes No m <br /> gt <br /> ➢ Does parcel require a Survey? Yes No O <br /> o � � <br /> °Q ➢ Permit application fees submitted? ❑ Amount S l>U,(�U Receipt# tp <br /> econciles with Real Property Lister Yes No Date: <br /> If not,explain: <br /> m <br /> 9J <br /> Applicatio Approve Denied Reason for Denial: <br /> Land Use: Date: <br /> 0 <br /> e <br />