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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: Mark and Juzell Pettis Buyer: Mikal and Mystie Anton -'o <br /> Address: 3984 State Road 70 Address: P. 0. .Box 122 i. <br /> Hertel, WI 54845 Siren, WI 54872 ° <br /> .;A <br /> Phone: 715-645-0331 Phone: C <br /> &Original Parcel Information <br /> A. <br /> Parcel ID#: 07-014-2-38-15-02-5 05-002-0110pction 2 Township 38N Range 15W v <br /> O <br /> Original Description (or attach copy): Government Lot Two (2) EXCEPTING the Southeast r> <br /> , <br /> Quarter (SE 1/4) thereof <br /> , ,; <br /> .d Current Zoning: Floodplain Y/N: Wetlands Y/N: Lake/River Class: <br /> 'o47- <br /> lrr <br /> w Name of Water Body: N/A Shoreland Agreement/SIPS YIN: N/A L <br /> Farmland Preservation Y/N: N/A Managed Forestry Law Y/N: N/A <br /> i, <br /> New Parcel Information <br /> 13 <br /> Proposed New Legal Description and Parcel Size: SEE ATTACHED RIDER n <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: Easement to Highway 70 C7 <br /> m <br /> Proposed access to public waters to be provided Y/N: No <br /> If yes, describe access: 1, <br /> 3/ d �a d <br /> Signature of Owner: I „, Date: / <br /> Mark Pettis + (((( 0 <br /> Signature of Owner:'i' 440 tat Date: Vc CJ/o?000 n <br /> Juzell Pettis <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> xt <br /> ➢ Does parcel require a Survey? Yes No <br /> o W. <br /> cn <br /> Permit application fees submitted? 0 Amount$502 Receipt#e-4<41 (c, W <br /> lj N <br /> l�Reconciles with Real Property Lister 3-3o- <br /> No Date.-1 nv • W <br /> o u <br /> cA If not,explain: —1i 4 X <br /> MAR 2 5 202A J <br /> Application: pprov / Denied Reason for Denial: Burnett County <br /> Land services Department <br /> �> <br /> Land Use: <br /> i���_A-A- 3//ai0 © Date: <br />