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Fees tnmst accompany ►bm►: <br />Burnett County Subdivision Permit Application Sut>,hviswni�IoSurvey• S50A0 <br />51k1'YtV tl('l.Xll"ling I'arceL• S50.001ot <br />and/or Pre -Application Form suwi„Sion Siirwr S21900 1 550tH►not <br />Owner: Secluded Land Company, LLC Buyer: <br />Address:PO Box 10 <br />- ..------- Address: <br />DeSoto, WI 54624 <br />1'110111: 608 648-2301 <br />Phone: <br />Original Parcel Information <br />Parcel ID #: 07-038-2-41-14-22- 3-02-000-011OMSection 22 Township 41N Range 1414 <br />Original Description (or attach copy): NW, Sid ex CSM V. 14 Pg.61 <br />Current Zoning: R-1 Floodplain Y/N: N Wetlands YIN: N Lake/River Class: n/a <br />Name of \Yater Body: Minirture Lake Shoreland Agreement/SIPS YIN: N <br />Farmland Preservation YIN: N Managed Forestry Law YIN: Y , being withdrawn <br />New Parcel Information <br />Proposed New Legal Description and Parcel Size: <br />kill V, <br />Acres: 10 - 0 7 <br />(if parcel is to be surveyed, provide preliminary snap. See attached for preliminary map requirements.) <br />Proposed access to public road: x rj A4CC P 55 eQ -f ✓� -eIt <br />� <br />Proposed access to public waters to be provided YIN: 'J/ <br />If yes, describe access: <br />Signature of Owner: <br />Signature of Owner: <br />r Does parcel in • owing Requirements? <br />i Does parcel require it Surver' <br />Permit application kes sithrnitted? <br />., <br />Date: / <br />Date: <br />No <br />Yes / No <br />Amount $ ='.A_%Un _,J Receipt # <br />0 Reconciles with Real Property Lister Yes No Date: <br />If not, explain: <br />Land <br />Denied Reason for Den <br />Date: / <br />R <br />In <br />.L <br />^. <br />