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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/Survey: $200.00+$50.00/lot <br /> owner: Fairview Dairy Farms Inc ( ( -i�� f— <br /> Buyer: o <br /> Address:23789 Peterson Rd Address: I l ( 2.. L Lt.t*. r,.t 1 S Jr. 3 <br /> Siren WI 54872 ( (_, '7 P <br /> .v <br /> Phone: 612-205-7829 Phone: I - 76- 5 4'(F% - Y 0 / c <br /> i <br /> Original Parcel Information <br /> Parcel ID#: 07-030-2-38-16-31-3 04-000-011000 Section 31 Township 38N Range 16W <br /> O <br /> Original Description(or attach copy): SE SW a <br /> eo <br /> 7) <br /> .t1 Current Zoning: A2 Floodplain Y/N: N Wetlands Y/N: N Lake/River Class: N/A E <br /> cv <br /> m Name of Water Body: N/A Shoreland Agreement/SIPS Y/N:N k. <br /> Farmland Preservation Y/N: Managed Forestry Law Y/N:N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: 5 acre CSM <br /> Acres:5 acre <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: C <br /> a <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: r <br /> Signature of Owner'\ _i°c) L �. c( lG,---�_. Date: `�-•- t-, _7.r_ <br /> Signature of Owner: ` Date: o <br /> 3 <br /> v <br /> > Does parcel meet Zoning Requirements? Yes No GF/_- it. (yam I a5 <br /> '' <br /> > Does parcel require a Survey? Yes No <br /> E. <br /> ['n se <br /> 0q <br /> )%' Permit application fees submitted? 0 Amount$ 27D r Receipt# <br /> t., 0 Reconciles with Real Property Lister Yes No Date: <br /> a <br /> = <br /> a. If not,explain: <br /> a <br /> O <br /> a <br /> G <br /> y <br /> Applicatio lApproved Denied Reason for Denial: / 472049 <br /> -.A iia' /e 'e'IO i 71- ►1e0 NSICe/l- �,���- <br />