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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision wo Survey: $50.00 <br /> and/or Pre-A lication Form Survey of Existing Parcel: $50.00lot <br /> pp Subdil•ision w'Survey: S-'00.00+550.00 lot <br /> Owner: Secluded Land Company Buyer: <br /> ' <br /> PO Box 10 <br /> Address: Address: 3 <br /> De Soto WI 54624 �, <br /> ts <br /> Phone: 800-782-1126 Phone: <br /> Original Parcel Information <br /> Parcel ID#: 07-016-2-39-17-23-2 02-000-011000 Section 23 Township 39N Range 17W �J <br /> Original Description(or attach copy): <br /> NW-NW <br /> n <br /> Current Cb <br /> Zoning: Fl Floodplain YIN: N Wetlands YIN: N Lake/River Class: <br /> Name of Water Body: N/A Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation Y/N: N Managed Forestry Law YIN:'' <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: CSM divide into 4 parcels <br /> Ii**4 <br /> Acres:40 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: 0 <br /> Proposed access to public waters to be provided Y/N: f? <br /> If yes,,describe access: <,-- <br /> Signat i re of Owner: f <br /> 06 <br /> �2 � �� <br /> Date: D��� !"`v <br /> Signature of Owner: J <br /> Date: <br /> a <br /> y Doves parcel meet Zoning Requirements? Yes No _ 60 Z.- - <br /> c Doesparcel require a Survey? <br /> q Y Yes No <br /> OD <br /> Permit mit application fees submitted? 0 Amount S Receipt# <br /> 1 <br /> i El Reconciles with Real Property Lister es No Date: k2p0 <br /> xIf not,explain: <br /> e <br /> 0 <br /> C. <br /> Applicatio • • pprov•. Denied Reason for Denial: <br /> 5e€4 rupae_ Mn,- 20-o,; <br /> Land U.S 0:0",MO Date: <br />