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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+$50.00/lot <br /> Owner: North Camp Properties II LLC Buyer: .0 <br /> tD <br /> Address:PO Box 66Address: g <br /> Danbury WI 54830 z <br /> 0 <br /> Phone: Phone: <br /> Original Parcel Information <br /> 07-020-2-40-16-02-5 05-002-011200,011500,011300 <br /> Parcel ID#: Section 02 Township 40N Range 16W <br /> O <br /> Original Description(or attach copy): <br /> Lot 2, 3&5 of CSM#4968 V28 P40-42 Located in GL 1&2 4 <br /> re <br /> .fl Current Zoning: RR2 Floodplain Y/N: Y Wetlands Y/N: N Lake/River Class: <br /> vs <br /> Gull Lake <br /> p Name of Water Body: Shoreland Agreement/SIPS Y/N; 't <br /> Farmland Preservation Y/N:N Managed Forestry Law Y/N:NZj <br /> New Parcel Information <br /> ILA <br /> Proposed New Legal Description and Parcel Size: CSM <br /> Acres: 3ip.5. R <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) 1\ <br /> Proposed access to public road: C <br /> It <br /> Proposed access to public waters to be provided Y/N: :I:_ <br /> h <br /> If yes,describe access: <br /> iii l .4v1-ADr12W /l A/ 'O� <br /> 2O <br /> Signature of Owner: M{M(arr Date: <br /> Signature of Owner: Date: g <br /> ➢ Does parcel meet Zoning Requirements? Yes No fly`66.z-7/ fD <br /> SI <br /> ➢ Does parcel require a Survey? Yes No <br /> op <br /> °r0 D Permit application fees submitted? 0 Amount$ 317-' Receipt# <br /> Ni <br /> on <br /> d IS Reconciles with Real Property Lister es No Date: 11/10/2C) <br /> W <br /> C C1\ <br /> If not,explain: <br /> A <br /> fl <br /> o <br /> a w <br /> y U, <br /> Application. pproved I enied Reason for Denial: v <br /> r. <br /> Land Use: /i//Z/� Date: <br />