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im <br />Burnett County Subdivision Permit Application <br />and/or Pre -Application Form or Map Review Form <br />Fees (must accompany form): <br />Subdivision w/o Survey: $50.00 <br />Survey of Existing Parcel: $50.00/lot <br />Subdivision w/ Survev: 8200.00 + $50.00/lot <br />Owner: Dallas L. Oman & Mary H. Dahlin -Oman Buyer: Craig Briggs <br />Address: 26449 Forli Ave Address; 14476 Ferry Road <br />Grantsburg, WI 54840 <br />Phone: (651)_428-660 t Phone:• (715)2220-1336 <br />OriEinal Parcel Information <br />Parcel ID #: 07-040-2-39-19-33-2 04-000-011000 Section 33 Township 39N Range 19W <br />Original Description (or attach copy): Southeast Quarter of the Northwest Quarter, Section 33, Township <br />39 North, Range 19 West, Town of West Marshland, Burnett County, WI. <br />Current Zoning:�fi h �` Floodplain Y/N: N Wetlands YIN: N Lake/River Class: N/A <br />Name of Water Body: N/A Shoreland Agreement/SIPS Y/N: N/A <br />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: South Half of the Southeast Quarter of the Northwest <br />Quarter, Section 33, Township 39 North, Range 19 West, Town of West Marshland, Burnett County, WI. <br />Acres: 20 <br />(If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Proposed access to public road: Gile Road <br />Proposed access to public waters to be provided Y/N: N/A <br />If yes, describe access: <br />Signature of Owner: Date: A::� j21 / <br />Signature of Owner: A4424 I i Date: 112 <br />IF <br />➢ Does parcel meet Zoning Requirements? Yes No <br />➢ Does parcel require a Survey? Yes No <br />Permit application fees submitted? Amount $ �) no Receipt # <br />❑ Reconciles with Real Property Lister Yes No Date: <br />If not, explain: <br />GIOUAITY <br />0 <br />