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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+$50.00/lot <br /> Owner: Thomas and Renee McDonough Buyer: Ramona M Hoffmann <br /> Address: 29141 County Road H Address: 29137 County Road H g <br /> z <br /> Danbury, WI 54830 Danbury, WI 54830 0 <br /> 612-396-1186 651-245-2849 <br /> Phone: Phone: <br /> Orieinal Parcel Information Q <br /> I <br /> Parcel ID#: Section Township Range ..0 <br /> O <br /> Original Description(or attach copy): = <br /> 29141 County Road H Tax ID# 17812 n <br /> D <br /> 29137 County Road H Tax ID# 17813 p <br /> 3 <br /> Current Zoning: RR2 Floodplain Y/N: N Wetlands Y/N: N Lake/River Class: t U+ <br /> rz Name of Water Body: Fish Lake Shoreland Agreement/SIPS Y/N: N <br /> Af <br /> .. Farmland Preservation Y/N: N Managed Forestry Law Y/N: N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: Proposed CSM rj <br /> 3 <br /> D <br /> Acres: I- <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: G <br /> so <br /> n <br /> Proposed access to public waters to be provided Y/N: �� <br /> Gi\ <br /> If yes,describe access: <br /> --.,_, <br /> Signature of Owner: ' % ! _ > `14- 7/erz.'t - Date: C J 7 O 2 .41 4 <br /> Signature of Owner: ° / Date: 4 - Dom. . . <br /> ills <br /> -o <br /> 5 <br /> > Does parcel meet Zoni�'equirements? Yes No /� s1/40,,,.° r, <br /> ➢ Does parcel require a Survey? Yes No <br /> °Q / <br /> �Z <br /> > Permit application fees submitted? 0 Amount$ ` Receipt#C_ e/tt/ J <br /> 0 Reconciles with Real Property Lister Yes No Date: v <br /> I. <br /> a pi <br /> a. If not,explain: <br /> n <br /> 0 <br /> a <br /> y <br /> Applicatio Approved /Denied Reason for Denial: <br /> Land Use: ///>/ -62, Date: <br />