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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: $50.00/lot <br />and/or Pre -Application Form Subdivision w/ Survev: $200.00 + $50.00/lot <br />Owner: Robert A. and Cheryl L. Viltz Buyer: <br />Address: 9126 Waldora Road Address: <br />Mikal Helland <br />9290 Waldora Road <br />Siren, WI 54872 Siren, WI 54872 <br />Phone: (715) 928-1625 Phone: (715) 349-2794 <br />Ori inal Parcel Information <br />P;xrcel ID #:07-006-2-38-17-15-4 03-000-011001 Section 15 Township 38N Range 17W <br />Original Description (or attach copy): see attached rider <br />Current Zoning: A2 Floodplain Y/N: No Wetlands Y/N: NO Lake/River Class: NO <br />Shoreland Agreement/SIPS Y/N: No <br />Managed Forestry Law Y/N: NO <br />Name of Water Body: <br />Farmland Preservation YIN: No <br />New Parcel Information <br />Proposed New Legal Description and Parcel Size: see attached rider <br />Acres: 14 <br />(If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Proposed access to public road: adjacent to Highway 70 and buyer owns ad ' acent L <br />witH access to Waiora Road <br />Proposed access to public waters to be provided Y/N: NO <br />If yes, describe access: <br />L7. <br />Signature of Owner: =w` G� tel' Date: <br />(,i� Iigbert A. �Vil�t�� _ }. <br />Signature of Owner:` t �, ` �.: Date: <br />Cheryl IL. Pi tT z <br />➢ Does parcel meet Zoning Requirements? <br />Does parcel require a Survey? <br />)�' Permit application fees submitted? <br />Yes No <br />Yes No <br />i <br />] Amount $ -�:>Qam Receipt # <br />❑ Reconciles with Real Property Lister Yes)No Date: ' <br />If not, explain: <br />Applica <br />Land Use: <br />/ Denied Reason for Denial: <br />C--1,7Date: <br />BURNETT COUNTY <br />ZONING <br />r <br />