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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: 550.00/lot <br /> .and/or Pre-Application Form or.Map Review Form _Subdivision w/Survey: $200.00+$50.0o/lot <br /> CA <br /> Owner: Fredrick R. Skahan andr____ <br /> Buyer: Michael A. Carlson <br /> Myra-J. Skahan ,_„. _.._ <br /> Address:1245 Gerson Road Address: 1268 ',arson Ro d <br /> Spooner, WI 54801 Spooner, WI 54801 W <br /> Phone: .T Phone: 715-416-2029 <br /> Orisvinal Parcel Information g <br /> Parcel ID#: 17969 Section 13 Township40 N Range 14 W . <br /> _. ._ g <br /> Original Description(or attach copy); See attached Rider <br /> �W X <br /> 3 <br /> Current Zoning:RR3 Floodplain YIN: N Wetlands Y/N; N _ _Lake/River Class: N/A T .. <br /> ,� Name of Water Body;__N/E1_, -___ __ Shoreland Agreement/SIPS Y/N;._ No <br /> Fgg <br /> armland Preservation YIN:.., N--, _Mana ed ForestryLaw Y/N: N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size:_See attached Rider ... _,,__ <br /> CV <br /> Acres: .10 i <br /> N-O <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: ' Carson Road ___ , ___________ iiik) <br /> Proposed access to public waters to be provided Y/N: No <br /> If yes,describe acces/ <br /> Signature of own . / 2T- Z S-- z.) <br /> ! _„_ ,_-- Date: <br /> Signature of Owner: • L, /, Date: f- Z f-r� G <br /> 4 <br /> D Does parcel meet Zoning Requirements? Yes No <br /> r D Does parcel require a Survey? Yes No <br /> g'as <br /> > Permit application fees submitted? 13Amount$ Receipt# <br /> ®Reconciles with Real Property Lister es No Date: 4:112,13,/-2.0 <br /> E . i <br /> If not,explain: <br /> 8 . __—___ f'_I!, gt492 ,�43 <br /> 1 Applicatio . Approved,, Denied Reason for Denial: 9E0E01%9E) <br /> .... <br /> Land Use: Date: <br /> ' .�.. 9 Z ?.O <br /> . zD . . SEP 2 8 2020 <br /> Burnett County �--_.,° <br /> Land Services Department <br />