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Fees (mast accompany form): <br />Burnett County Subdivision Permit Application Subdivision w'o Survey: S50.00 <br />Survey of Existing Parcel: S50.00:1ot <br />and/or Pre -Application Form Subdivision w' Swrev: 5200.00—S50.00.1ot <br />Owner: Kenneth & Peggy McCune Buver: Kenneth & Peggy McCune <br />- i a <br />Address: 23698 Larson Road Address: 23698 Larson Road jl! 0 <br />Z* <br />Grantsburg Wi 5484G Grantsburg,..Wl 54840 <br />Phone: 115-4J1—VJ/J x'uvuc, T <br />Original Parcel Information <br />07-010-2-38-19-16-4 03-000-011000 <br />Parcel ID #: -L-2--ac-A-01 026160 WO0 Tax 0#: 4183 Section 116 Township 38 Range 19 <br />Original Description (or attach copy): Gee Doc #234473 <br />Current Zoning: A2 Floodplain YIN: Wetlands YIN: <br />Lake/River Classification: Class 3 Name of Water Body: Ray Greek <br />Shoreland Agreemt or SIPS YIN: —Farmland Preservation YIN: Managed Forestry Law Y/N: <br />New Parcel Information e� 1 1 ,i � (o : )37-I %g <br />Proposed New Legal Description and Parcel Size: Lot 1 (7.94 Acres±), Proposed CSM <br />(Lot 1 to include this entire parcel and part of two others - see attached) <br />Acres: 5.21 from this parcel <br />(If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Proposed access to public road: Existing driveway west to Larson Drive <br />Proposed access to public waters to he provided YIN: N <br />If ves, describe access: <br />Signature of Owner: _r - , � l t t <br />� t^ ti .,�---• <br />Date: �%t} <br />C) 7fW <br />Signature of Owner: c 1'yj / ✓ iL <br />�; J <br />Date: 2- 12 <br />i+ Does parcel meet Zoning Requirements? <br />Yes No <br />Does parcel require a Survey? <br />Yes No <br />iY Permit application fees submitted? <br />:3moarnt S o _— <br />Receipt #, <br />Q Reconciles with Real Property Lister <br />Yes No Date: <br />If not, explain: <br />_ <br />Applicati . Approved / nied Reason <br />for Denial: <br />_ <br />Land Use: <br />MAY 18 2017 <br />BURNETT COUNTY <br />ZONING <br />