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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> and/or Pre-A lication Form Subdivision w/o Survey: $10.00 <br /> PP Subdivision w/Survey:$100.00+$15.00/lot <br /> Owner: Rurick R. & Frances Mattson <br /> Address: 11295 Mattson Rd. <br /> B <br /> Luck, WI 54853 Phone: 715/327-8264 z <br /> 0 <br /> Oridnal Parcel Information <br /> 034-1535-01 600 and <br /> Parcel Identification#: 034-1535-01 700 Section 35 Township 37 Range18 U <br /> Original Description(or attach copy): _1 ) NES NW3, J <br /> 2 ) Parcel in NW; NW; , described as follows : Commencing at the p <br /> Southeast corner , thence N. 80 rods, thence W. 80 rods , thence S. C3 <br /> 28-zeds-'irktac�ea Sot�th���r=rly tM-he point of hegi g Pyrppt_ <br /> y cne w. 4ou Leet . <br /> Current Zoning: AC Floodplain YIN: N Wetlands Y/N: N <br /> n <br /> Lake/River Classification: NA Name of Water Body: NA <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: (See legal attached) <br /> Acres: 37 <br /> 7 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: via Mattson Road <br /> Proposed access to public waters to be provided Y/N• N <br /> If yes,describe access: <br /> m <br /> submitted 13Y <br /> Signature of Owner: ,/_D �i:.� Date: <br /> Ql <br /> e ➢ Does parcel meet Zoning Requirements? Yes No d <br /> J <br /> ➢ Does parcel require a Survey? Yes No <br /> Permit application fees submitted? ❑ Amount$ Receipt# <br /> t <br /> e <br /> r <br /> � ❑ Reconciles with Real Property Lister Ye; : No Date: <br /> If not,eaplaiu: ` fix U cll Td — o An amolk k�*d o c <br /> C6 Masai N ` <br /> W N <br /> T U( <br /> P O <br /> Application: pproved / enied Reason for Denial: J <br /> a � <br /> Land Use Date: �}�d <br />