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Burnett County Subdivision Permit Application Fees(must accompany fonn): <br /> Subdivision w/o Survey: $10.00 <br /> and/or Pre-Application Form Subdivision w/Survey:$100.00+$15.00/lot <br /> Owner: Douglas J. Coyour <br /> Address: 22501 Coyouur Rd. <br /> A <br /> Frederic, WI 54837 Phone: 715-653-2695 z <br /> 0 <br /> Ori 'nal Parcel Information <br /> Pt. of 07-014- - <br /> ParcelIdentification Rt. of 07-014-2-38-15-32-3 02-0043M660 32 Township 38N Range 15W <br /> Original Description(or attach copy): See Tax Statements <br /> O <br /> e <br /> y b <br /> Current Zoning: unzoned Floodplain Y/N: No Wetlands Y/N: No <br /> n <br /> Lake/River Classification: Name of Water Body: <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: See Attached <br /> P <br /> Acres: 20.0 d <br /> S <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: over easement to 360th Ave. <br /> Proposed access to public waters to be provided Y/N: NO <br /> If yes,describe access: C <br /> m <br /> Signature of Owner: v Date: <br /> e ➢ Does parcel meet Zoning Requirements? Yes No n <br /> J <br /> ➢ Does parcel require a Survey? Yes No <br /> 0 <br /> ➢ Permit application fees submitted? ❑ Amount$ (D Receipt# <br /> C <br /> m ❑ Reconciles with Real Property Lister /Yes No Date: <br /> If not,explain t <br /> 0 , p <br /> CSYI ` , oX)�t— <br /> I'D 1 0gl t/ / — S IL.Piw _Rl .Slyrt CV M' (lI ., L� yyyUS��� <br /> 0. <br /> 1J� w <br /> , <br /> 0 0 <br /> Applicatio . Approve enied Reason for Denial: W P <br /> w � <br /> o $ <br /> Land Use: Date: <br /> �a� <br />