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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 /> Subdivision $200.00+$50.00/lot <br /> and/or Pre-Application Form <br /> Duane V. & Cheryl L. Johnson <br /> Owner: <br /> Gary S. & Jane C. Bell Buyer: Duane V. & Cheryl L. Johnson <br /> .y <br /> 12324 County Rd. D 12304 County Rd. D "g <br /> Address: Address: — <br /> Grantsburg, WI 54840 Grantsburg, WI 54840 0 <br /> 715-463-2559 715-463-2750 <br /> Phone: Phone: <br /> Orieinal Parcel Information <br /> Parcel ID#:07-042-2-38-18-05-4 02-000- Section 5 Township 38N Range 1gW <br /> 011000 <br /> Original Description(or attach copy): See attached addendum <br /> A <br /> ♦ 1 <br /> 'fl 9 <br /> Current Zoning: Floodplain Y/N: Wetlands YIN: <br /> Lake/River Classification:__. Name of Water Body: <br /> Shoreland Agreemt or SIPS Y/N1 :_sFarmland Preservation YIN:_Managed Forestry Law Y/N:_ <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: See attached addendum <br /> Acres: y <br /> P <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) , <br /> Proposed access to public road:access through <br /> Property already owned by Owners. C <br /> Proposed access to public waters to be provided YIN: 2 <br /> 2 <br /> If ves,describe access: <br /> Sigrature.f Owner: Date: G <br /> Signature of Owner: �A�rY l/ � Date: <br /> e <br /> Y Does parcel meet Zoning Requirements? Yes No y <br /> o <br /> o' <br /> ➢ Does parcel require a Survey? Yes No G <br /> oa <br /> Permit application fees submitted? A () Receipt# X <br /> t l7 Reconciles with Real Property Lister Yes No Date: <br /> �o If not,explain: U{ <br /> a <br /> N <br /> O <br /> Application: Approved / Denied ,Reason for Denial: UC, 4/ W'DUv <br /> Q <br /> Land Use: Date* —��O <br />