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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: Diana Naylor Buyer: Mathy Constructionit <br /> Address:28827 Old 35 RdAddress: %Monarch Paving 3 <br /> Danbury WI 54830 768 US Highway 8; Amery, WI 54001 z <br /> 0 <br /> 715-656-3911 715-492-0065 <br /> Phone: Phone: <br /> Original Parcel Information <br /> 07-020-2-40-16-09-3 04-000-011200 09 40N 16W <br /> Z. <br /> Parcel ID#: _ Section Township Range <br /> Original Description(or attach copy): Lot 2 CSM#4826 V27 P57 (SW SW & SE SW) <br /> 3. <br /> Ts Current Zoning: A2 <br /> Floodplain Y/N: N Wetlands Y/N: N Lake/River Class: <br /> Ts <br /> As Name of Water Body: N/A Shoreland Agreement/SIPS Y/N: Pj <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N: N 7okP D <br /> ra <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: CSM dividing existing parcel into 2 lots <br /> Acres: 19.79 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: C7 <br /> m <br /> n <br /> Proposed access to public waters to be provided Y/N: <br /> If yes, describe access: <br /> Signature of Owner: , ��f , A 2, L. Date: $/oLY <br /> Signature of Owner:C?�� .cy�!�� 11�Agent for Mathy Construction Date: 8/21/2020 <br /> ts <br /> > Does parcel meet Zoning Requirements? Yes No R,___ p/3//ze <br /> N -�6o&Jc) <br /> 0 ➢ Does parcel require a Survey? Yes No <br /> 5' <br /> CI: TI Permit application fees submitted? 0 Amount$ 3oO.�- d <br /> Receipt# l <br /> C., Reconciles with Real Property Lister GD No Date: 9il jaQ <br /> n <br /> 0 <br /> c If not,explain: <br /> es <br /> en0 <br /> 7 <br /> Application• • pproved / l enied Reason for Denial: / / <br /> 0,5/1"- I a, lu..Gto trKGraz • • v/.5104_, - NO iteAA) /041/oAie <br /> Land Use: • V/0 2.0 2.0 Date: <br />