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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 /> w,-,er, <br /> Owner: Steve ;a Tanski Lak.: �;,cZeckSkW1�e�'� b <br /> m <br /> Address: 28767 Kilkare Green Way Address: Qs--1 0 K 1 ,ire 6ccen\fa g <br /> Danbury WI 54830 —3D8.r'v\wir WI 54130 o <br /> 651-246-5158 c G <br /> Phone: Phone: �I -P-4.+ JO`ic Qp <br /> ' Original Parcel Information <br /> 07-028-2-40-14-16-4 03-000-014001,03-000-014100 <br /> Parcel ID#: Section 16 Township 40N Range 14\N 95-- <br /> O-- <br /> Lot 1 & Lot 2 CSM#4077 V21 P213 SW-SE <br /> Original Description(or attach copy): a <br /> eD <br /> .a Current Zoning: Cl Floodplain YIN: N Wetlands Y/N: N Lake/River Class: �� <br /> w Name of Water Body: N/A Shoreland Agreement/SIPS Y/N: <br /> I? <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N: N V) <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: CSM changing lot lines on 2 existing parcels <br /> Acres: 1.72 <br /> (If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: C <br /> a <br /> ri <br /> Proposed access to public waters to be provided Y/N: <br /> .\ <br /> If yes,describe access: <br /> VW , ' 0 <br /> Signature of Owner:,,f'4 Date: 4q-I / 0 N <br /> d <br /> Signature of Owner: cToi-altL �ar, il1G i.'1 Date: V- o <br /> -o <br /> a <br /> Does parcel meet Zoning Requirements? Yes No « $/3//z <br /> 40 rDN <br /> °o Y Does parcel require a Survey? Yes No y�_. 6 D Lt W <br /> crc Permit application fees submitted? ❑ Amount$ /t9U' Receipt# tr <br /> J <br /> NJ Reconciles with Real Property Lister C) No Date: 9/1/ao ..14)- <br /> la <br /> zIf not,explain: <br /> o U <br /> a- v7([ <br /> C 1 <br /> /Application. Approved Denied Reason for Denial: <br /> Aci last4it' 1.e. ac ' Zoo$ O&-vci , !JLIIL N• OH /.Of Z aNd ''re?'C. a D —Co •eibi 1;" <br /> Land Use: /0 AZO Date: <br />