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sm <br />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 or Map Review Form Subdivision w/ Survev: 5200.00 + S50.00/lot <br />Owner: Dwight & Ruth Anderson Buyer: Kyle & Melissa Anderson <br />Address: _12391 County Road D Address: 2620A 210' Ave. <br />Grantsburg, WI 54840 St. Croix Falls, WI 54024 <br />ULyirxIMrr 483-9564 <br />Original Parcel Information <br />Parcel ID #: Part of 07-042-2-38-18-08-102-000-011000 Section 8 Township 38N Range 18W <br />Original Description (or attach copy): The NW'/ NE'/. Section 8. Township 38 North, Range 18 West <br />Burnett County, WI, EXCEPTING therefrom the North 660' of the West 330' thereof. <br />Current Zoning• r._.. d— Floodplain Y Wetlands Y/N:f Lake/River Class: N/A <br />Name of Water Body: , /el L ()"pd/' Shoreland Agreement/SIPS Y/N: N/A <br />t <br />Farmland Preservation Y/N: N i"t eN Managed Forestry Law Y/N: N <br />New Parcel Information <br />Proposed New Legal Description and Parcel Size: The NW '/ NE Y4. Section 8, Township 38 North, Range <br />18 West, Burnett County, WI, EXCEPTING therefrom the North 660 feet thereof. <br />Acres: 20 <br />(If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Proposed access to public road: County Road D <br />Proposed access to public waters to be provided Y/N: N/A <br />If yes, describe access: <br />Signature of Owner:4tn, � Date: 2--- (C — Cl <br />Signature of Owner: Date: <br />➢ Does parcel meet Zoning Requirements? Yes No OL <br />➢ Does parcel require a Survey? <br />Permit application fees submitted? ❑ <br />❑ Reconciles with Real Property Lister Yes <br />I -- <br />If not, explain: <br />Application: Approved / Denied <br />Land Use: <br />Yes No <br />19,14-9Amount $ �� • Receipt # <br />No Date: <br />Reason for Denial: p <br />Date: <br />3� <br />J"r <br />