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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivisionw/o Survey: 550.00 <br /> and/or Pre-Application Form Survey of Existing Parcel: S: /lot <br /> PP Subdivisionw/Survey: (200.00+$SO.00Aot <br /> Owner: Tregenza, Edward F. Jr Buyer: Deutsch, Robert I. and Jean M. <br /> and Michelle C. <br /> Address: 37682 North U.S. Route 12 Address: 1220 Stout Street 3' <br /> Spring Grove, IL 60081 Menomonie, WI 54751 0 <br /> Phone: 847-587-7484 Phone: 715-231-4211 UJ <br /> W <br /> W <br /> Original Parcel Information <br /> i� <br /> Parcel ID#: 07-028-2-40-14-16-2 04-000-011000 Section 16 Township 40 Range 14 O <br /> Original Description(or attach copy): SE 1/4 NW 1/4 <br /> b � <br /> e <br /> ^^ Current Zoning: � Floodplain Y/�)i Wetlands Y/N: }Y <br /> Lake/River Classification: Name of Water Body: t IJTT <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Sue: 5 112 of SF 1 /4 NW 1 /4 <br /> S <br /> re <br /> Qz <br /> Acres: 20 S <br /> N <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: County Road H <br /> Proposed access to public waters to be provided Y/N: N m <br /> A <br /> If yes, describe access: <br /> pN Signature of Owner: f, ( s�,� ,�,r„y,f� /� Date: % ©T <br /> 0 <br /> e' <br /> °Q Signature of Owner: n <br /> Date• o <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> e ➢ Does parcel require a Survey? yes j�ro at <br /> a o <br /> Permit application fees submitted? ❑ Amount$c5-6, 0 (D Receipt# <br /> o OO <br /> � t <br /> a <br /> ❑ Reconciles with Real Property Lister Yes ---) No Date: <br /> If not,explain: <br /> d <br /> 0 <br /> Application Approve Denied Reason for Denial: 0 <br /> Land Use: Date: r —� <br />