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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br /> and/or Pre-A lieation Form Survey of Existing Parcel: $50.00/lot <br /> hP Subdivision w/Survey: $200.00+$50.00/lot <br /> Owner: Warren Shore Buyer: <br /> -o <br /> Address:28521 Chalet Rd Address: <br /> Danbury WI 54830 © <br /> Phone: <br /> L' ( � "ff�d -- 66 ‹( 7 Phone: C G <br /> Original Parcel Information <br /> Parcel ID#: 07-012-2-40-15-14-4 02-000-011000 Section 14 Township 40N Range 15W ��,,,, <br /> Original Description(or attach copy): NW SE a'\I <br /> et <br /> -.o Current Zoning: PDD Floodplain Y/N: Y Wetlands Y/N: Y Lake/River Class: <br /> = <br /> a Name of Water Body: N/A Shoreland Agreement/SIPS Y 1 c <br /> a <br /> Farmland Preservation Y/N: N Managed Forestry Law YIN: N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: CSM <br /> Acres:4.15 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: C7 <br /> a <br /> Proposed access to public waters to be provided Y/N: oQ <br /> If yes, describe access: �� <br /> Signature of Owner: FDate: 7 -3,9 `a J <br /> Qir <br /> Signature of Owner: Date: a <br /> b <br /> ➢ Does parcel meet Zoning Requirements? Yes No R, 7/?°/7"° <br /> etN &.e Z/lv <br /> © > Does parcel require a Survey? Yes No <br /> ° ,.y� ro4ki'll <br /> 7c.� > Permit application fees submitted? 0 Amount$ 27 v ' Receipt# <br /> o() <br /> 6eReconciles with Real Property Lister No Date: 8/4/0/8a20 <br /> a <br /> a. If not,explain: <br /> 7J <br /> e <br /> eta <br /> 0 <br /> G <br /> Application: pproved / Denied Reason for Denial: <br /> I <br /> Land Use: taw- y< </ ?� R-' Date: <br />