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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 />JP Cattle Co Trust <br />Owner: C/o Jim M e l i n Buyer: IV <br />Address: 21071 Melo Drive <br />Grantsburg, WI 54840 <br />Phone: 715— 56 6 — 0161 <br />Address: <br />Phone: <br />Original Parcel Information <br />Lego cyy##034150501600 Tax ID#23264 <br />Parcel ID#: 07-0,-2-37-18-05-2 01-000-011000 Section 5 <br />Township 37 Range 18 <br />Original Description (or attach copy): NE 1 /4 of NW1 /4 described <br />in Doc.# 434322 <br />Current zoning: A Floodplain Y/N: <br />Wetlands Y/N: <br />Lake/River Classification: Name of Water Body: <br />Shoreland Agreemt or SIPS Y/N: Farmland Preservation Y/N: <br />Managed Forestry Law Y/N: <br />New Parcel Information <br />Proposed New Legal Description and Parcel Size: Lot 1, Proposed <br />CSM <br />Acres: 5.0 <br />(If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Proposed access to public road: Assembly Road <br />Proposed access to public waters to be provided Y/N: N <br />If ves, describe access: <br />Signature of Owner: �� Date: <br />Signature of Owner: W4e_e-i� Date: <br />➢ Does parcel meet Zoning Requirements? Yes No Ae. c. ZA-2-119 <br />➢ Does parcel require a Survey? Yes No <br />o� Rod <br />➢ Permit application fees submitted? ❑ Amount $ 2 5-01 Receipt # <br />❑ Reconciles with Real Property Lister Yes No Date:_ <br />If not, explain: <br />Applicatio Approved / De3 ied Reason for Denial: <br />2 <br />W� <br />