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JUN-21-::016 11 :33 P.01101 <br /> Burnett County Subdivision Permit Application I 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: Ronald and Diane Beauvais Buyer: Debra Johnson b <br /> A <br /> Address: 25821 Lhotka Road Address: 6960 Ticonderoga Trail S <br /> R <br /> z <br /> Webster WI 54893 Eden Prairie, MN 55346 ° <br /> Phone: Phone: <br /> 612-209-8050 <br /> Original Parcel Information (j <br /> Parcel ID#: 07-016-2-39-17-22-2 02-000-011000 Section 22 Townsbip 39N Range 17W <br /> O <br /> Original Description(or attach copy): The Northwest Quarter of the Northwest Quarter <br /> (NA NW-4), Section 22, Township 39 North, Range 17 West, Burnett County, <br /> Wisconsin. <br /> W <br /> o Current Zoning: A-2 Floodplain Y/N: No Wetlands Y/N: No Lake/River Class: N/A <br /> V <br /> wName of Water Body: Shoreland Agreement/SIPS Y/N: <br /> d <br /> Farmland Preservation Y/N: No Managed Forestry Law Y/N: No <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: The North 15 acres of the NW4 NW-14, Section <br /> 22, Township 39 North, Range 17 West, with Grantor retaining an easement over <br /> the West 33 feet thereof for the benefit of the Acres: 15 <br /> South 25 acres thereof. <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: Black Brook Road d <br /> Proposed access to public waters to be provided Y/N: No <br /> If yes,describe access: <br /> 00 <br /> Signature of Owner: IIYII ''l-L Date: <br /> Ro 1 $ea ai <br /> n <br /> _��r;� <br /> Signature of Owner: r _ Date: ° <br /> iane Beauvais � <br /> r c <br /> ➢ Does parcel meet Zoning Requirements? /Y'es ./ No <br /> o ➢ Does parcel require a Survey? Yes <br /> 0 <br /> 0O D Permit application fees submitted? Amount$�._ � Receipt# <br /> r 0 Reconciles with Real Property Lister /// Yes No Date: <br /> e <br /> ° if not,explain: <br /> ° <br /> a <br /> N <br /> Applicat' n: Approved / enied Reason for Denial: <br /> Land Use — Date: 6o 7_ ZOl r <br /> TOTAL P.01 <br />