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e e <br /> 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 Subdi vision w/Survev: $200.00+$50.00/lot <br /> Owner: Kevin Fossum Buyer: <br /> Address: 12025 Little Trade Rd Address: <br /> R <br /> Grantsburg, Wl 54840 0 <br /> Phone: Phone: <br /> Orizinal Parcel Information <br /> Parcel ID#: 07-034-2-37-18-21-505-003-034000 Section 21 Township3 7N Range 18W <br /> O <br /> Original Description(or attach copy): Lot 1 CSM V18 P168 (#345485) (Frrrily CSM V16 P271 0 <br /> & CSM V4 P172 - Gov Lot 2) <br /> C <br /> Current Zoning:_BB2_Floodplain YN:�_Wetlands YIN: N Lake/River Class: a' <br /> C <br /> Name of Water Body: Little Trade Lake Shoreland Agreement/SIPS Y/N.N �1 <br /> Farmland Preservation Y/N:N Managed Forestry Law Y/N:N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: 2 lot CSM dividing existing parcel <br /> Acres:3.8 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: C7 <br /> m <br /> R <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: <br /> Signature of Owner: . Date: <br /> Signature of Owner: Date. <br /> b <br /> ➢ Does parcel meet Zoning Requirements? Yes No A <br /> 0 ➢ Does parcel require a Survey? Yes No <br /> 6,9,0 <br /> oA <br /> °Q ➢ Permit application fees submitted? ❑ Amount$ Receipt# <br /> t. ❑Reconciles with Real Property Lister Yes No Date: <br /> 22 <br /> 0 <br /> ° If not,explain: <br /> 0 <br /> a <br /> Applicatio Approved enied Reason for Denial: <br /> &�H S vQ SS v / S/ �'' 10 ► 1? <br /> Land Use: !9 Date: <br />