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Fees (nxw wxompany form): <br />Burnett County Subdivision Permit Application s"v;sim who survey: $50.00 <br />Survey of Existing Parcel: S50.00/lot <br />and/or Pre -Application Form SuMiAsionw/Survev: $200.00+S50.OMot <br />Owner: Ryan & Katie Tjoder Buyer: No change <br />Address: 810 Juniper Drive Address: (Combining two parcels into one) <br />Somerset, WI 54025 <br />Phone: bbl -491 - <br />Phone: <br />Original Parcel In[gEMation <br />07-006-2-38-17-16-5 05-006-019000 <br />Parcei tD#: 07-006-2-38-17-16-5 05-006-020000 Section 16 Township 38 Range 17 <br />Original Description (or attach copy): Two parcels in Government Lot 6 <br />as described in Doc.# 430593 and 430594 <br />Current Zoning: R R 1 Floodplain Y/N: <br />Wetlands Y/N: <br />Lake/River Classification: Class 1 Name of Water Body: Mud Hen Lake <br />Shoreland Agreemt or SIPS YIN: Farmland Preservation Y/N: Managed Forestry Law YIN:, <br />New Parcel Information 1 ,� ___�OLP <br />Proposed New Legal Description and Parcel Size: Lot 1, Proposed CSM <br />(Combining two parcels into one) <br />Acres: 0.48 <br />(If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Proposed access to public road: N M u d h en Lake Drive <br />Proposed access to public waters to be provided YIN: N <br />If ves. describe access: <br />Signature of Owner: i Date: r' ! <br />Signature of Owner: Date: <br />r <br />➢ Does parcel meet Zoning Requirements? Yes No <br />➢ Does parcel require a Survey? Yes No <br />Permit application fees submitted? Amount $ o Co Receipt # <br />13 Reconciles with Real Property Lister Yes No Date: <br />If not, explain: <br />Applicad • Approved / nied Reason for Denial: <br />Land Use: s� = /o/y// 7 Date:ni <br />MAY 1$ 2 <br />0 <br />J <br />BURNETT COUNTY <br />ZONING <br />