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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+$50.00/lot <br /> Owner: Fred Kruger Buyer: •d <br /> tt <br /> Address:27102 County Rd A Address: i <br /> Spooner WI 54801 p <br /> CA <br /> Phone: Phone: VI' <br /> Original Parcel Information t <br /> 07-024-2-39-14-02-1 03-000-011000,07-024-2-39-14-02-1 03-000-012000,07-024-2-39-1402-1 04-000-012000,07-024-2-39-14-02-2 04-000-011000 g) <br /> Parcel ID#: Section 02 Township 39 Range 14 C <br /> N 1/2 SW NE Lyg E of CTH A Ex CSM V14 P145,Lot 1 CSM V14 P145(SW NE&SE NE), 4 <br /> Original Description(or attach copy): 0 <br /> N 1/2 SE NE Lyg E CTH A Ex E 20 Rds&Ex CSM V14 P145,That Prt SE NW Lyg NE of Co Rd A K <br /> i <br /> a Current Zoning: RR2 Floodplain Y/N:Y Wetlands Y/N: Y Lake/River Class: <br /> b <br /> m• <br /> Name of Water Body: Lost Lake Shoreland Agreement/SIPS Y/N: <br /> d <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N: N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: 4 existing lots revised to 4 new lots <br /> Acres:33.24 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: t7 <br /> m <br /> n <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: <br /> Signature of Owner: r s A/ Date: 4 v' 2 7-10Z <br /> IIi <br /> Signature of Owner: ' . /f, - / Date: — Z -- n <br /> 1 v <br /> D Does parcel meet Zoning Requirements? Yes No ii //5,/w ZO 5, <br /> 0 > Does parcel require a Survey? Yes No (o c�7 <br /> t �`� Vi <br /> °Q > Permit application fees submitted? 0 Amount$ �� Receipt# �� <br /> J <br /> , 0 Reconciles with Real Property Lister Yes No Date: <br /> >v <br /> 0 <br /> cl' If not,explain: v, u,r 1/4.))i <br /> n V\ <br /> o --.l ...1 <br /> . <br /> p <br /> y <br /> Application: r pproved 1 enied Reason for Denial: <br /> Land Use: • �0 Date: <br />