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Burnett County Subdivision Permit Application F (mom accotapany lam): <br /> and/or Pre-Application Form or Review Form iai wla Duey; 50.00 <br /> p ew Survey of Existing Parcel: 50M/lot <br /> ubdivi.,a gat wf%rvcv, SM00+'fit}MInt <br /> Owner. Eric C Assn Buver. W <br /> Address: 1892 22 1 T Address. <br /> z <br /> RICE LAKE WI 54868 P <br /> Phone; - 1- <br /> 8695 Phone: <br /> CWginal Parcel Informntian <br /> Parcel ID Ml 028922502200 Section 5 Township Range 14 <br /> Original Description(or attach copy). Leta 1 s 15 and the West 50' ofLot 16, Pink Knoll A <br /> z <br /> Subdivision <br /> Current Zoning. RR-2 Floodplain YIY. Wetlands YtN. N Lake/River Mass. <br /> Name of Water Body. Fish Shoreland Agreement/SIPS YIN; <br /> •a <br /> Farmland Preservation YRN. Managed Forestry Law Y/N: <br /> .« 1`Lm �' I <br /> el nformatigA <br /> Proposed New Legal Description and Parcel Size. This CSM merges Lot 15 with the W5 ' of Lot 16, <br /> and se2arettes, Lot 14 backinto a sinaielot. <br /> Acres: .€ <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> a to public read- <br /> Proposed <br /> c irisKnoll <br /> Prot access to public waters to be provided Ylt . <br /> If yes,describe aces: <br /> lure of ' Date. <br /> aignature oo tamer. ,A� �c .._ vats: <br /> c <br /> y Does parcel meet Zoning Requireme a? Yes Itio =� <br /> r I)ws parcel require a Survey? Yes No <br /> c <br /> Permit applic ativn fees suhmi`tted? ® Amount Receipt <br /> as <br /> ❑ Reconciles with Real Property Lister Yes No Date; <br /> If not,explain,- <br /> Application- Approved I Denied Reason for Denial. <br /> Land Use: Date. <br />