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��- Fees (must accompany form): <br />Burnett County Subdivision Permit Application Subdivision vv/o Survey: $50.00 <br />Survey of Existing Parcel: $50.00/lot <br />and/or Pre -Application Form Subdivision vv/ Survev: $200.00 + $50.00/lot <br />Owner: Daniel Flodin/ Flodin Construction, LLC Buyer: .� <br />Address: PO Box 141 Address: <br />Siren, WI 54872 z <br />0 <br />Phone: (715) 349-5062 Phone: C <br />C�= <br />Original Parcel Information <br />07-030-2-38-16-18-3 03-000-011100 141 <br />Parcel ID #: 07-030-2-38-16-18-3 03-000-011001 Section 18 Townshi 3p 8N Range 16W W <br />Original Description (or attach copy): Lot 1 CSM V23 P105 (ER SW S4 & FIR SVV SW Fx F 300' <br />of W 850 of S 726 & Ex CSM 217 P 10 & Ex CSM V20 P191 & Ex CSM V23 P105 <br />Current Zoning: RR1 Floodplain Y/N: N Wetlands Y/N: Y Lake/River Class: N/A <br />Name of Water Body: N/A Shoreland Agreement/SIPS Y/N: N/A <br />Farmland Preservation Y/N: N Managed Forestry Law Y/N: N <br />New Parcel Information <br />Proposed New Legal Description and Parcel Size: <br />2 Parcel CSM (1 outlot and 1 Lot) modifying lot lines <br />Acres: 7 . 6 3 <br />(If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Proposed access to public road: e <br />Proposed access to public waters to be provided /N: <br />If yes, describe access: <br />Signature of Owner: �'� Wit''' Date: <br />Signature of Owner: Date: <br />n <br />0 <br />3 <br />> Does parcel meet Zoning Requirements? Yes Ao A_c' -51 Zf o <br />Does parcel require a Survey. Yes No <br />i Permit application fees submitted? ❑ Amount S / Receipt 9 f <br />--:i <br />❑ Reconciles with Real Property Lister Yes No Date: <br />If not, explain: <br />Application: rApprovo <br />/ Denied Reason for Denial: <br />Land Use: <br />Date: r , ' % f <br />