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i <br />Fees (must accompany form): <br />Burnett County Subdivision Permit Application Subdivision wio Survey: $50.00 <br />Survey of Existing Parcel: S50.00/lot <br />and/or Pre -Application Form Subdivision w/ Survev: 5200.00 +$50.001lot <br />Velva Bauer Revocable Trust <br />Owner: c/o representative Priscilla Bauer Buyer: Reed and Becky Bogardus <br />Address: 13204 Assembly Road <br />Grantsburg, Wi 54840 <br />Phone: 715-222-2195 <br />Address: 22789 County Highway 61 <br />Pine City, MN 55063 <br />Phone: 763-957-0682 <br />OriOnal Parcel Information <br />07-010-2-38-19-36-3 04-000-011000 <br />Parcel ID #: 07-010-2-38-19-36-4 03-000-011000 Section 36 <br />Township 38 Range 19 <br />Original Description (or attach copy): See Doc.##388805 <br />Current Zoning: A2 Floodplain Y/N: <br />Wetlands Y/N: <br />Lake/River Classification: Name of Water Body: <br />Shoreland Agreemt or SIPS Y/N: Farmland Preservation Y/N: <br />Managed Forestry Law Y/N: <br />New Parcel Information <br />Proposed New Legal Description and Parcel Size: Lot 1 Proposed <br />CSM V r1 P Ih <br />Acres: 8.0 <br />(If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Proposed access to public road: Assembly Road <br />Proposed access to public waters to be provided Y/N: N <br />If ves, describe access: <br />Signature of Owner: � C � Date: � <br />� �7/(:� �����/\ <br />Signature of Owner: Date: <br />➢ Does parcel meet Zoning Requirements? Yes No <br />➢ Does parcel require a Survey? Yes No <br />Permit application fees submitted? Amount IV Receipt # <br />❑ Reconciles with Real Property Lister Yes <br />If not, explain: <br />No <br />bURNETT COUNTY <br />ZONING <br />IN <br />W, <br />