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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br /> Survey of Existing Parcel: $50.00Aot <br /> and/or Pre-Application Form Subdivision w/Survev: 5200.00+$50.00/tot <br /> Owner: Christine L Erickson Buyer: Randy & Carol Soderbeck V <br /> Address: Linda J Halacy Address: 24869 Soderbeck Rd <br /> Carol L Soderbeck Grantsburg, WI 54840 <br /> z <br /> X13 10 Qcl n/e15 -7o W <br /> Phone: Phone: 463-9596 (T <br /> Orieinal Parcel Information <br /> Parcel ID#: 040-3535-03 000 Section 35 Township39 Range18 <br /> O <br /> Original Description (or attach copy): NW SE, Sec. 35-39-18, Burnett County, WI. <br /> n, <br /> n <br /> ,t <br /> Current Zoning: _D.- Floo�dp1la�in YN:�Wetland�Y/N: Lake/River Class:�/" <br /> 9 Name of Water Body: /"r/ r Shoreland Agreement/SIPS Y/N: /0 4 <br /> F Farmland Preservation Y/N: Managed Forestry Law Y/N: <br /> New Parcel Information l7rC <br /> Proposed New Legal Description and Parcel Size: W 850' of S 525' NW SE, Sec 35-39-18, <br /> Burnett County, WI. 10.2 acres <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: Lundquist Rd O <br /> m <br /> Proposed access to public waters to be provided Y/N: a <br /> If yes,describe access:(!./� Q <br /> Signature of Owner: AV_4� Date: 7-3 -Ae,,L ! t <br /> Signature of Owner: b0 L Date: 7-3•da/2 3 <br /> C <br /> ➢ Does parcel meet Zoning Requirements? Yes No 'Tib A`F bra r � <br /> ➢ Does parcel require a Survey? Yes No <br /> 0 <br /> °0 ➢ Permit application fees submitted? ❑ Amount$ Receipt# d <br /> U' <br /> r, Reconciles with Real Property Lister Yes No Date: W <br /> ° If not,explain: <br /> W <br /> JUL 10 2012 <br /> y <br /> Application Approved Denied Reason for Denial: ZONING <br /> Land Use: Date: ��rl <br />