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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> and/or Pre-Application Form Subdivision w/o Survey: 510.00 <br /> Subdivision w/Survey:$100.0o+sIs.00/lot <br /> Owner: Rurick R. & Frances Mattson <br /> Address: 11295 Mattson Rd. A <br /> 0 <br /> Luck, WI 54853 Phone: 715/327-8264 z <br /> 0 <br /> Oritrinal Parcel Information <br /> 034-1535-01 600 and <br /> Parcel Identification#: 034-1535-01 700 Section 35 Township 37 Rangel8 <br /> Original Description(or attach copy): 1 ) NES NWy J <br /> 2) Parcel in NW, NW; , described as follows: Commencing at the C <br /> Southeast corner, thence N. 80 rods, thence W. 80 rods , thence S. A <br /> 'e a e *er] Y * rh r r f hegia.ning �-- <br /> M Current Zoning: AO Floodplain YIN: N N <br /> P Wetlands YIN: <br /> Lake/River Classification: NA Name of Water Body: NA <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: (See legal attached) <br /> Acres: q 7 <br /> 7 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: via Mattson Road <br /> Proposed access to public waters to be provided Y/N: N <br /> If yes, describe access: <br /> t7 <br /> submitted y• <br /> m <br /> Signature of Owner: _ /_y i, Date: U) <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> ➢ Does parcel require a Survey? Yes No <br /> Permit application fees submitted? ❑ 10) <br /> Amount$ l61 (]0 Receipt# / <br /> 4 <br /> r <br /> ❑Reconciles with Real Property Lister Yeg. No Date: <br /> a � <br /> 64 If not,eaplain:_Q 411 !l <br /> �p �� _ (gyp o C� c <br /> n. r C1mrtiTf <br /> w <br /> W CN <br /> ui <br /> O <br /> Application: pproved / enied Reason for Denial: <br /> J h` <br /> Land Use: Date: ��d <br />