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Burnett County Subdivision Permit Application Fees (must accompany form): <br />and/or Pre -Application Form or Ma Review Form Subdivision w/o Survey: $50.00 <br />i'p P Survey of Existing Parcel: $50.00/lot <br />Owner: <br />Address: <br />Bill Hallock <br />32021 E ADAMS LAKE RD <br />DANBURY WI 54830 <br />Phone! 7/5 a __'S�ZD 0 3 <br />Subdivision w/ Survev: 5200.00 + S50.00/lot <br />Buyer: John Hallock <br />Address: PO BOX 417 a <br />SPOONER WI 54801 0 <br />Phone: <br />Original Parcel Information <br />004613403510,004613403520 <br />Parcel ID #: &07-004-2-42-14-34-505-001-011001 Section 34 Township 42 Range 14 <br />Original Description (or attach copy): Lot 1, Burnett County Certified Survey Map No. 2231, <br />Lot 2, Burnett County Certified Survey Map No. 3034, and unplatted lands, <br />located in Gov. Lot 1, Section 34, T42N-R14W. <br />Current Zoning: RR -1 Floodplain Y/N: N Wetlands Y/N: N ✓ Lake/River Class: N% X <br />Name of Water Body: Adams Lake / Shoreland Agreement/SIPS Y/N: N <br />Farmland Preservation Y/N: N Managed Forestry Law Y/N: N <br />New Parcel Information <br />Proposed New Legal Description and Parcel Size: Pre -deeding has been completed to modify the boundary <br />between these former lots and add lands to create a new lot that meets the current lot require- <br />ments. This new CSM shows the results of the deeding. Acres. 2.29 Acres <br />(If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Proposed access to public road: 25' Access Easement to E. Adams Lake Road <br />Proposed access to public waters to be provided Y/N: N <br />If yes, describe access: <br />Signature of Owner: t ",/A Date: <br />,tgnature of owner: tate: <br />➢ Does parcel meet Zoning Requirements? Yes No <br />➢ Does parcel require a Survev? Yes No <br />Permit application fees submitted? Amount $ 11n � i Receipt # <br />❑ Reconciles with Real Property Lister <br />If not, explain: <br />Applicatio <br />Land Use: <br />Yes No Date: <br />aL'"NETT COUNTY U <br />ZONING <br />