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Fces (inust accompany form); <br />Burnett County Subdivision Permit Application Subdivision w/o Survey $50.00 <br />and/or Pre -A lication Form Survey of Existing Parcel: $50.0011ot <br />PP Subdivision <br />w/ Survev: $200.00 + $5200/tot <br />Owner: Robert Plummer Buyer: <br />Address: 30304 N First Ave Address: 3 <br />Danbury, WI 54830 0 <br />Phone: (218)370-8041 <br />Phone: <br />Original Parcel. Information <br />� <br />07-032-2-41-16-28-103-000-012000 <br />� <br />Parcel ID #: & 07-032-2-41-16-28-1 03-000-013000 Section 28 Township 41 Range 16 <br />Q10 <br />Original Description (or attach copy): PCLS SW NE DESC IN #411693 EX S 181'� <br />& S 181' of PCLS DESC #411693 <br />0 <br />er <br />Current Zoning: 11 & RR1 Floodplain YIN: N Wetlands Y/N: N Lake/River Class: N/A <br />r� <br />-�+- <br />Name of Water Body: N/A Shorcland Agreement/SIPS Y/N: N/A <br />-6 <br />Farmland Preservation YIN: N N1.11'aged Forestry Law Y/N: N <br />� <br />New Parcel Information <br />Proposed New Legal Description and Parcel Size: New 2 Lot CSM <br />� <br />Acres: 2.4 +/- <br />(If parcel is to be surveyed, provide preliminary map. Sec attached for preliminary map requirements.) <br />Proposed access to public road: Existing- N First Ave <br />Proposed access to public waters to be provided YIN: N <br />If yes, describe access: <br />Signature of Owner: <br />Signature of Owner: <br />➢ Does parcel meet Zoning Requirements? <br />Y Does parcel require a .Survey? <br />Date:., r %'- <br />Date: <br />Yes Yo Gk 7 % <br />res Aro A eG <br />dd <br />A Permit application fees submitted? ❑ .Amount S Receipt i! <br />❑ Reconciles with Real Property Lister Yes No Date: <br />If not, explain: <br />Applicati Approved I nied Reason for Denial: — --- <br />Land U <br />Date: <br />tv <br />l.7 <br />A <br />1 <br />O_ <br />00 <br />