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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 Subdivision w/Survev: $200.00+$50.00/lot <br /> Owner: <br /> Owner: Jeff Sventek Michael Carlson <br /> Address. 11717 Pine Lake Rd Address- 2615 Park Ave Apt 204 <br /> Frederic WI 54837 Minneapolis MN 55407 <br /> Phone: 715-431-0782 Phone: <br /> Original Parcel Information Q <br /> 07-034-2�7-1&22-2 04-000-012000 d <br /> 07-034-237-18-22-2 03-00"11000,47-034-2-37-18-22-2 03-00AG12000, 37 Range 18W �] <br /> Parcel ID#: Section 22 Township <br /> O <br /> Original Description(or attach copy): SE NE,E1/2 SW NW,W1/2 SE NW <br /> �s <br /> Current Zoning: RR3 Floodplain YIN: N Wetlands Y/N: Y Lake/River Class: <br /> �o <br /> Name of Water Body: Shoreland Agreement/SIPS YIN: <br /> Farmland Preservation Y/N:N Managed Forestry Law Y/N:N <br /> Ne-*v Parcel Information <br /> Proposed New Legal Description and Parcel Size: Certified Survey Map <br /> Acres:3.37+/- g, <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: Ci <br /> Proposed access to public waters to be provided Y/N: A <br /> If yes, describe access: <br /> Signature of Owner: <zWc111-� Date: f 111 J/ "'I <br /> Signature of Owner: Date: o <br /> Y Does parcel meet Zoning Requirements? Yes No P., <br /> Does parcel require a Survey? Yes O'�o o® <br /> 2® <br /> Permit application,fees submitted? © Amount$ Rwe't# ' p162 <br /> D o <br /> r., ❑Reconciles with Real Property Luster Yes No Date: <br /> :v <br /> If not,explain: <br /> W <br /> 19 U- <br /> �' G <br /> a <br /> AppHc• do p enied Reason f r De ial: <br /> Land Use: Date: <br />