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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+$50.00/lot <br /> Owner: o r ` o onR?r/vr6LAn Buyer: Tammy Morse � <br /> Address: 8380 N Bass Lake Rd Address: 28861 E Bass Lake Rd <br /> Danbury WI 54830 Danbury WI 54830 ° <br /> G <br /> Phone: Phone: eP <br /> Original Parcel Information <br /> 07-036-2-40-17-12-4 03- <br /> Parcel ID#:07-036-2-40-17-12-403-000-%1eatgp0 12 Township 4ON Range 17W <br /> O <br /> Original Description(or attach copy): SW SE LYQ W of East Bass Lake Rd <br /> tT( <br /> 1� <br /> Current Zoning: RR1 Floodplain Y/N: N Wetlands Y/N: N Lake/River Class: p <br /> Name of Water Body: Shoreland Agreement/SIPS YIN: <br /> a <br /> '. Farmland Preservation YIN: N Managed Forestry Law Y/N: N P <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size:._ 3Lot CSM 5 <br /> Acres: 27 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: C7 <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: n s <br /> Signature of Owner: �'/ re -�� �tUate: q�/ <br /> Signature of Owner: Date: o <br /> ti <br /> a <br /> > Does parcel meet Zoning Requirements? Yes rvo R <br /> G ➢ Does parcel require a Suivey? Yes No Ak- <br /> a <br /> a• <br /> Q0 Permit application fees submitted? ❑ Amount$ 3 5'77 V Receipt# <br /> �. ❑ Reconciles with Real Property Lister Yes No Date: <br /> a <br /> ° If not,explain: <br /> n <br /> 0 <br /> c <br /> Application Approve Denied Reason for Denial: <br /> Land Use: 9j�w— �,�-'"_"_•_.___. Date: <br />