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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+$50.00/lot <br /> Owner: John Cherne Buyer: b <br /> (13 <br /> Address:28750 Trout Springs Dr Address: B <br /> - <br /> Danbury WI 54830 o <br /> 715-259-3481 __ <br /> Phone: Phone: CO <br /> Original Parcel Information <br /> 07-012-240-15-15-5 15-754-016000,07-012-2-40-15-15-515-754017000,07-012-2-40-15-15-5 15-754-018000,07-012-2-40-15-15.5 15-754-019000 <br /> Parcel ID#: Section 15 Township 40N Range 15W <br /> O <br /> Original Description(or attach copy): Trout Spring Add to Voyager Village Lots 6-9 4 <br /> CDd <br /> D--- <br /> ) <br /> .� Current Zoning: PUD Floodplain Y/N: N Wetlands Y/N: N Lake/River Class: <br /> .a <br /> oName of Water Body: N/A Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation Y/N:N Managed Forestry Law Y/N:N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: CSM to combine existing lots <br /> Acres: 0.S 3 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: d <br /> m <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: '`3 <br /> Signature of Owner: • ( 1vv L Date: -25- 202 <br /> )...01 t, . Date: 6 - z c-2ozo <br /> Signature of Owner: o <br /> B <br /> b <br /> c <br /> ➢ Does parcel meet Zoning Requirements? Yes No A Gc� 7/2-V <br /> -5 <br /> N <br /> > Does parcel require a Survey? Yes No Cl- 60 zo 7 .424 <br /> a. <br /> 0° D Permit application fees submitted? ❑ Amount$ Jv Receipt# <br /> t ® Reconciles with Real Property Lister CO No Date: 7/ <br /> so <br /> o N <br /> °' If not,explain: SP <br /> r3 '46 <br /> n <br /> 0 -...! <br /> 0. <br /> (J�� <br /> y <br /> Application. Approved / I enied Reason for Denial: op <br /> Land Use: _ _ Date: 7/Z y/--gyp <br />