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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+$50.00/lot <br /> Owner: Nancy Mccormack Buyer: <br /> Address:29905 Tower Rd Address: <br /> Danbury WI 54830 <br /> c'Sl <br /> Phone: Phone: <br /> Original Parcel Information <br /> till II)7 <br /> Parcel ID#: 07-032-2-41-16-36-2 04-000-011000 Section 36 Township 41N Range 16W <br /> Original Description(or attach copy): PCI SE-NW <br /> CD <br /> Current Zoning: RR? Floodplain Y/N: Y Wetlands Y/N: Y Lake/River Class: <br /> Name of Water Body: Cranberry I ake Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N: N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: CSM <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: C7 <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: <br /> Signature of Owner '3'' <�,.� � � Date: //— O — Q'a <br /> Signature of Owner: Date: <br /> . <br /> 6 <br /> / o <br /> Zoning 9 de, -- 2_ 3'7 <br /> 7 <br /> ➢ Does parcel meetRequirements?' Yes No <br /> N � <br /> ➢ Does parcel require a Survey? Yes No <br /> o' <br /> 0° ➢ Permit application fees submitted? ❑ Amount$ 5/ Receipt# <br /> v 0 Reconciles with Real Property Lister Yes No Date: <br /> If not,explain: <br /> A <br /> a <br /> 0 <br /> Application. pprove Denied Reason for Denial: <br /> -.1111 <br /> Land Use: taW. , Date: ? zDZd <br />