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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+$50.00/lot <br /> Owner: E1 Rose Johnson Buyer: James and Patricia Melin <br /> 21690 N. Bass Lake Rd. 21071 Melo Dr. 3 <br /> Address: Address: <br /> Grantsburg, WI 54840 Grantsburg, WI 54840 0 <br /> Phone: <br /> 715-488-2211 Phone: 715-488-2261 <br /> Orieinal Parcel Information <br /> Parcel ID#: 034151701600; 034151701500 Section 17 Township 37N Range 18W d <br /> O <br /> Original Description(or attach copy): Govt. Lots 1 & 2 (91.29 acres) <br /> A <br /> Z <br /> m <br /> 0 Current Zoning: Floodplain Y/N: Wetlands Y/N: Lake/River Class: <br /> a Name of Water Body: Shoreland Agreement/SIPS Y/N: <br /> '9 <br /> A* Farmland Preservation YIN: Y Managed Forestry Law Y/N: N S <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size:Parcel 1 Govt. Lot 2 and the N 1 320 feat of <br /> Govt. Lot 1, Sec. 17-38-18 (80 acres) Parcel 2) Govt. Lot 1, EXCEPT for the N <br /> 1320 feet_ Ser 1 R Tarn sen To Srante;=, her heirs, assignees, inv+te , <br /> and others coming lawfully on to the premises an easement ffo in ress, egress a <br /> id <br /> 11prtilittieVs E2 rM nth ovor 2nd across The Acres: 1I.�19 ares <br /> pf earceltista be surven�l,d�oviedea eliminar ma See attached for preliminary ma requirements.) <br /> P Y P P Y P• P Y P 9 ) <br /> Proposed access to public road: r s rved Pnsompnt O <br /> m <br /> Proposed access to public waters to be provided Y/N: N <br /> If yes,describe access: <br /> C-U <br /> Signature of Owner: e a Date: 31110- <br /> Signature <br /> 10'-"Signature of Owner: Date: c 1 <br /> 3 <br /> ➢ Does parcel meet Zoning Requirements? Ye� No t)V 70 (kr Gi f a, 3-rr-i7 e4-1 <br /> x <br /> ➢ Does parcel require a Survey? Yes No <br /> ae ➢ Permit application fees submitted? 7rAmount$ moi( ).V� Receipt# <br /> X_ _ w <br /> m ❑ Reconciles with Real Property Lister � Yes _ No Date: 91 <br /> � If not,explain: i <br /> c O <br /> a <br /> y a <br /> ApplicatApproved Denied Reason for Denial: {� <br /> Ar <br /> I <br /> Land Use: Date: <br />