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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: S200.00+$50.00/lot <br /> Owner: Charles and Constance Houman Buyer: It <br /> Address:29460 CCC Rd Address: <br /> Danbury, WI 54830 0 <br /> Phone: Phone: t� <br /> Original Parcel Information _-Z <br /> Parcel ID#: 07-020-2-40-16-02-5 05-002-011000 Section 02 Townshi 4p ON Range 16W <br /> Original Description(or attach copy). PCL Gov Lot 1 &2 Ex PCL V234 P516 D-52 <br /> C� <br /> .o Current Zoning: RR2 Floodplain Y/N:___N Wetlands Y/N: N Lake/River Class: <br /> m Name of Water Body: Shoreland Agreement/SIPS Y/N: N <br /> 0 <br /> Farmland Preservation Y/N:N Managed Forestry Law Y/N:N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: 1 Lot CSM <br /> Acres:.73 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road:Existing t7 <br /> Proposed access to public waters to be provided Y/N:N <br /> If yes,describe access: O <br /> Signature of Owner: ` W. �iYYI-�-�y'1 Date: c`S 'I�/ — /C� <br /> Signature of Owner: Date: o <br /> ,o <br /> ➢ Does parcelRequirements? Yes No <br /> N P <br /> o ➢ Does parcel require a Survey? Yes No <br /> 0° ➢ Permit application fees submitted? ❑ Amount$,60 Receipt# elutt- <br /> t. ❑Reconciles with Real Property Lister Yes No Date: N <br /> Q- If not,explain: <br /> 7� <br /> 0 <br /> -s <br /> a+ <br /> Applicatio . pproved Denied Reason for Denial: <br /> See Gu ►° 9 <br /> Land U 9 119 1 1 1 Date: <br /> 0, <br /> LINt �t <br />