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I <br /> Fees(must accompany form): <br /> Burnett County Subdivision Perini Application Subdivision vii.Survey: $54.00 <br /> and/or Pre-Application F 'n1 Survey of Existing Parcel $50.00/lot <br /> Subdivision vn/Survey: 5200.00+$54.40 lot <br /> Owners Fairview Dairy Farms Inc <br /> li;uyer: <br /> ro <br /> Address:23789 Peterson Rd z <br /> Address: . <br /> Siren WI 54872 <br /> a <br /> Phone: ;Phone: C <br /> CP <br /> Original Parcel Information <br /> 07-006+.1713.203-000-0tiuo. -006-1,2a-47-13102-C O012001,int-W&2.38-11.13201400.011001 <br /> Parcel ID#: <br /> 1 Section +3 Township 38" Range sTw, <br /> Original Description(or attach capy)- <br /> SW-NW,NW-NE NE NW O <br /> h <br /> 3 Current Zoning: AVM Floodplain Y/N <br /> F etiands YIN: Lake/River Class: <br /> N. <br /> 0, Name of Water B <br /> `' Shoreiand Agreement/SIPS Y/N <br /> Farmland Preservation YIN:N lfanaged Forestry Law Y/N:N , <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: CSM{creating 3 new Parcels <br /> ..,,, <br /> � Acres:61-35 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> C <br /> Proposed access to public waters to be provided Y/N: 1 <br /> If yes,describe access: '` <br /> ,/Signature of Owner: X, ....-- I Date: V""p ""6 6 <br /> Signature of Owner: Date: <br /> Does parcel meet Zoning Requirements? ro <br /> Yes No 4.___3f6 ('j O/�o ro <br /> N .r <br /> 1 > Does parcel require a Survey? Yes No <br /> to <br /> as <br /> > Permit application fees submitted? 0 Am utrt$ 351,1 i <br /> Receipt <br /> r. I]Reconciles with Real Property Lister Yes I No Date: 1 <br /> v <br /> Is <br /> If not,explain: <br /> Pao <br /> i <br /> j V4 <br /> Application: Approved Denied Reason for Denial: <br /> U` <br /> Land Use: ze2e Date: <br />