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Hees(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-Application Form Subdivision w/Survev: $200.00+$50.00/lot <br /> Owner: Nylene Wicklund Buyer: Spencer Wicklund <br /> t <br /> Address: 21479 County Road M Address: 12749 County Road 0 9 <br /> z <br /> Frederic, WI 54837 Grantsburg, WI 54840 v,) <br /> Phone: 715-327-4694 Phone: 715-431-0221 <br /> 1:P_ <br /> OriOnal Parcel Information lJ` <br /> 07-034-2-37-18-19-1 02-000-011000 <br /> Parcel ID#: 034151901300 Section 19 Township 37 Range yr <br /> Original Description(or attach copy): NW 1/4 of NEl/4 described in Doc.## 435190 <br /> ti <br /> a � <br /> C <br /> Current Zoning: A Floodplain Y/N: N Wetlands Y/N: Y 1 <br /> Lake/River Classification: Name of Water Body: <br /> Shoreland Agreemt or SIPS Y/N: Farmland Preservation Y/N: Managed Forestry Law YIN: <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: Lot 1, Proposed CSM , 96 'P � '9qr <br /> Acres: 5.00 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: County Road 0 <br /> C <br /> Proposed access to public waters to be provided Y/N: N A <br /> If ves,describe access: <br /> Signature of Owner: Date:X/ C c <br /> " I <br /> Signature of Owner: Date: <br /> n <br /> 3 <br /> ➢ Does parcel meet Zoning Requirements? Yes No R <br /> Does parcel require a Survey? Yes No O <br /> Permit application fees submitted? Amount$ -)l). Receipt# Q <br /> o ❑ Reconciles with Real Property Lister / \Yes No Date: <br /> a � <br /> If not,explain: Uj <br /> I' <br /> 0 <br /> a 0p <br /> Applicatio . Approved / nied Reason for Denial: <br /> 30- 116 3 em CotiSOIWokA 111 -0u <br /> Land Use: ?hl �S Date: BURN TT i°(S! lfJTy <br /> ZONING <br />