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Burnett County Subdivision Permit ApplicationnSubdii'on <br /> ccompany form): <br /> w/oSurve and/or Pre-Application Form W1SurveyS100.iro+sls.00nat <br /> Owner: Glen Albee and Brenda Albee <br /> 7 <br /> Address: 2865 Sand Road 3 <br /> Shell Lake, WI 54871 Phone: 715-463-2037 e <br /> Orieinal Parcel Information <br /> Parcel Identification M 008-2116-01 600 Section 16 Township 38N Ra ge 14W <br /> Original Description(or attach copy): SEI NEI, S16, T38N, R14W, Burnett Co. , WI <br /> E <br /> a • <br /> b � <br /> Current Zoning: A (Exclusive Ag) Floodplain Y/N: Wetlands Y/N: <br /> Lake/River Classification: n/a Name of Water Body: n/a <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: see attached addendum <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map require ents.) <br /> Proposed access to public road: <br /> Signature of Owner: / Date: <br /> Go <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> Does parcel require a Survey? Yes No <br /> n <br /> ➢ Permit application fees submitted? ❑ Amount S 0, D D Receipt# 3 <br /> 9 <br /> C <br /> r n <br /> 6 <br /> � <br /> El Reconciles with Real Property ListerYes No Date: <br /> a / o <br /> If not,explain: <br /> e <br /> a SL <br /> u 1 <br /> 1 <br /> Applicgtio A D Hied Reason for Denial: SADw r <br /> iNl 6e or S <br /> a <br /> Land Use: Date: 9-//— 0 'er_ <br />