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Pees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br /> and/or Pre-Application Form Survey ofExistingwti Survey: <br /> el: 00.00Ilot <br /> Subdivision w/5urvev: 3200.00+550.00/lot <br /> Owner: Richard Brown Buyer: ..o <br /> Address: PD Box 637 Address: 9 <br /> Spooner WI 54801 z <br /> P <br /> Phone: e <br /> Phone: S� <br /> Original Parcel Information <br /> 07-008-2-38-14-02-5 05-003-011000,07-008-2-38-14-2-5 05-005-011000 <br /> Parcel ID#: Section 02 Township 38N Range 14W <br /> Original Description(or attach copy): Gov Lot 3 &Gov Lot 5 74 <br /> S <br /> 71 <br /> r. <br /> Current Zoning: A Floodplain Y/N: N Wetlands Y/N:Y Lake/River Class: <br /> c Name of Water Body: NA Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation Y/N: N Managed Forestry Law YIN:N <br /> New Parcel Information <br /> "r <br /> Proposed New Legal Description and Parcel Size: CSM to combine 2 existing lots <br /> S <br /> Acres: L-1'5 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: O <br /> Proposed access to public waters to be provided Y/N: I� <br /> If yes,describe access: <br /> \c-i) <br /> ignature of Owner: Date: 31 <br /> A9 <br /> Signature of Owner: Date: o <br /> 3 <br /> m <br /> - c <br /> i- Does parcel meet Zoning Requirements? Yes No ck 6 D zz3 <br /> 0 Does parcel require a Survey? Yes No <br /> mo <br /> Q° i Permit application fees submitted? ❑ Amount$ SV Receipt# <br /> t- (EI Reconciles with Real Property Lister es No Date: Pie/5/a0 <br /> c <br /> c. If not,explain: <br /> n <br /> o <br /> 0 <br /> c <br /> G <br /> h <br /> Applicatio Approved /)enied Reason for Denial: <br /> ...111111P 2- Z�/ZO267 <br /> Land Use: � � — Date: <br />