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J <br />fees (must accompany form): <br />Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br />Survey of Existing Parcel: 550.00,1ot <br />and/or Pre -Application Form <br />Subdivis <br />ion w. Sun•cv: 5200.00 ,- :650.00ilot <br />K -Wood Truss Rafters, Inc. <br />Owner: Alma Karels c/o Cynthia Leonard j <br />Address: 22131 Spir't Lake Rood E Address: 23368 Uitle Wood Lake Road <br />Frederic, WI 54837 <br />Phone: 7115-689-2502 <br />Gran`,sburq, WI 54840 <br />Phone: .'1 5--G 89- 250. - <br />Original Parcel Information <br />07-042-2-38-18-24-3 02-000-012000 <br />Parcel ID #: 07-042-2-38-18-24-3 02-000-C13000 Section 24 <br />Township 38 Range 18 <br />Original Description (or attach copy): See Doc. #,1406385 and <br />406384 <br />Current Coning: Unzoned Floodplain Y/N: <br />Wetlands Y/N: <br />Lake/River Classification: Name of Water Body: <br />Shoreland Agreemt or SIPS Y/N: Farmland Preservation Y/N: <br />Managed Forestry Law Y/N: <br />New Parcel Information <br />Proposed New Legal Description and Parcel Size: Lots 1, Proposed CSM <br />Acres: 7•92ac <br />(If parcel is to be surveyed, provide preliminary map. See attached for <br />preliminary map requirements.) <br />Proposed access to public road: Little Wocd Lake Road <br />Proposed access to public waters to be provided Y/N: <br />If ves, describe access: <br />Signature of O Date: <br />Signature of Ower: Date: ,moi <br />1 Does parcel meet Zoning Requirements? Yes No <br />Y Does parcel require a Survey? <br />yes No <br />Y Permit application fees submitted? ❑ Amount $__ Receipt # ____ <br />❑ Reconciles with Real Property Lister Yes No Date: <br />If not, explain: <br />Land Use: <br />Reason for Denial <br />Z©1g Date: <br />1� - <br />IQ <br />�9 <br />