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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 />a <br />Owner: Glen Museus Buyer: David O'Neill <br />Address: 1191 River Rd Address: 152 Sylla St <br />Dresser, WI 54009 River Falls, WI 54022 <br />Phone: 715-501-9319 Phone: 715-781-2209 <br />Original Parcel Information <br />07-020-2-40-16-29-5 15-050-017000 <br />Parcel ID #: 07-020-2-40-16-29-5 15-050-018000 Section 29 Townshi 4p ON Range 16W <br />07-020-2-40-16-29-5 15-050-019000 <br />Original Description (or attach copy): Big Yellow Lake Estates Lots 7. 8. & 9 <br />Current Zoning: RR Floodplain Y/N: Y- AE Wetlands Y/N: Y Lake/River Class: - <br />Name of Water Body: Yellow Lake Shoreland Agreement/SIPS Y/N: <br />Farmland Preservation Y/N: N Managed Forestry Law Y/N: N <br />New Parcel Information <br />Proposed New Legal Description and Parcel Size: New 2 lot CSM combining 30' of Lot 8 with Lot 7 <br />and combining the remainder of Lot 8 with Lot 9 <br />Acres: 2.08 <br />(If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Proposed access to public road: <br />Proposed access to public waters to be provided Y/N: <br />If yes, describe access: <br />Signature of Owner: �l-v . �y�i ��� ai1_._.�. Date: <br />Signature of Owner: �Q �� / �!✓y Date: <br />➢ Does parcel meet Zoning Requirements? Yes No <br />➢ Does parcel require a Survey? Yes No <br />Permit application fees submitted? ❑ Amount $ Za-7�1— Receipt # l7'pCJ <br />❑ Reconciles with Real Property Lister Yes No <br />If not, <br />Land Use: <br />Approved / enied Reason for Denial: <br />Z 71 / / Date: <br />C <br />m <br />A <br />10 <br />0 <br />3 <br />b <br />a <br />