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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+$50.00/lot <br /> Marjorie Cook <br /> Owner: Buyer: "d <br /> Address: PO Box 395 Address: B <br /> Danbury WI 54830 <br /> 0 <br /> C <br /> Phone: Phone: �P <br /> Original Parcel Information <br /> Parcel ID#:07-032-2-01-1e-20-303-000-012000.07-032-2-11-16-20-303-000-011000 Section 20 Township 41N Range 16W t <br /> O <br /> Original Description(or attach copy): PGSwSW <br /> 3 <br /> Current Zoning: RR3 Floodplain Y/N: N Wetlands Y/N: " Lake/River Class: , <br /> r Name of Water Body: Shoreland Agreement/SIPS Y/N: (1 <br /> �` <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N: N g <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: CSM to add on to existing parcel <br /> Acres: 11.91 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: C <br /> _ <br /> Proposed access to public waters to be provided Y/N: "l7` <br /> If yes,describe access: <br /> Signature of Owner:' /:1r�¢" fXf7 � Date: <br /> Signature of Owner: Date: o <br /> ➢ Does parcel meet Zoning Requirements? Yes No s <br /> N <br /> ➢ Does parcel require a Survey? Yes No II /1 <br /> cm _ ( ' <br /> D Permit application fees submitted? 0 Amount$ .2-d " Receipt N al <br /> oP *4) <br /> t40 N <br /> r IWReconciles with Real Property Lister A No Date: 5-11 -cgOa) •.D <br /> c If not,explain: <br /> o 5, ECE1119E =;\ lJ <br /> Applicatio.. Approved / i enied Reason for Denial: n, MAY 6 2020 <br /> Land Use: / 7f 7� Date: Burnett County 4 <br /> Land Services Department <br />