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Fees (must accompany form): <br />Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br />Survey of Existing Parcel: $50.00/lot <br />and/or Pre -Application Form Subdivision -,v/ Survev: 5200.00 + $50.00/lot <br />Owner: DGI -Danbury LLC Buyer: W.C. King Properties LLC <br />Address:200 E Washington St Ste C Address: P.O. Box 128 <br />Appleton, WI 54830 Danbury, WI 54830 <br />Phone: (920) 560-5069 <br />Phone: <br />Orieinal Parcel Information <br />Parcel ID#:07-032-2-41-16-28-1 04-000-020000 Section_a�Township 41N Range 16W <br />Original Description (or attach copy): See attached <br />Current Zoning: C1 Floodplain Y/N: N Wetlands Y/N: N Lake/River Class: N/A <br />Name of Water Body: N/A Shoreland Agreement/SIPS YIN: -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: See attached <br />Acres: <br />(If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />New parcel to be conveyed to the neighbor to the east, access <br />Proposed access to public road: will be via existing connection <br />Proposed access to public waters to be provided Y/N: N <br />If yes, describe access: <br />Signature of Owner:Acd AK <br />Date: 12/18/2017 <br />4V 4F <br />Signature of Owner: Date: - <br />Y Does parcel meet Zoning Requirements? Yes No 1-2_/'ZZ/ 17 /, <br />N <br />Y Does parcel require a Survey? Yes No <br />a" Permit application fees submitted? ❑ Amount $ 3�' Receipt # <br />�. ❑ Reconciles with Real Property Lister Yes No Date: <br />v <br />a <br />If not, explain: <br />0 <br />s <br />a <br />Applicatio . Approved/ enied Reason for Denial: <br />Land Use: / �/� Date: <br />00 <br />n <br />0 <br />z <br />4t <br />