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Fres (must accompany form): <br />Burnett County Subdivision Permit Application Subdivision w/o Survey: S50M <br />Survey of Existing Parcel: S50.001lot <br />and/or Pre -Application Form Subdivision <br />w/Survrv: S200.00 + $50.GWut <br />Owner I'mpad North, Inc gayer: <br />ftta*60 P.O. Box 274 A <br />Address Address: <br />K <br />Gordor^i, WI 54838 c <br />Phone: Phone: <br />Oridnal Parcel information <br />Parcel ID #: p 038=v2�Y/-9y P2� � o3 -c:, -o- c7/1 yDo Section_,?8: Township. Range <br />Original Description (or attach Y SIl1 (���} <br />d <br />/ �c+opy): '�! 11 <br />14 i <br />Current Zoning: RR I Floodplain Y6.YO_,,,_Lake/River Class: <br />eName <br />of Water Body: Shoreland Agreement/SIPS <br />.. <br />Farmland Preservation Managed Forestry Law- <br />New Parcel Information V � rtl'Og C' <br />Proposed New Legal Description and Parcel Size: C5m U/ e's <br />ca � t,J2s � t�e S Ilia; yes Z R c� •- <br />Acres: �3'm /(�jp <br />(if parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Proposed access to public road: <br />v <br />Proposed access to public waters to be provided Y/N: IVA <br />If yes, describe access: <br />U1 <br />Signature of Owner -,Date: 3/ 28/ 17 <br />�. <br />Signature of Owner: Date: <br />n <br />0 <br />> Does parcel meet Zoning Requirements? yes No <br />n <br />D Does parcel require a Survey? yeS No <br />> Permit applicatlon fees submitted? J_ Receipt H <br />0 Reconciles with Real Property Lister Yes No Date: <br />a <br />If not, explain: <br />0 <br />a <br />w <br />y, <br />Appiicati Approved i enied Reason for Denial: <br />Land Use:' - !f <br />Date: <br />// <br />mh�� f`oF Go `l CS/j'� �, 8' ..-r u3f__ �e e!ah� Viq <br />p►^ <br />/,r 1-4- <br />wi`rl�it:1 S /ylorliS ml�iiS a���vda�� <br />