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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+$50.00/lot <br /> Owner: David Nelson Buyer: <br /> Address:28753 Spotted Fawn Rd Address: 3 <br /> • <br /> Danbury WI 54830 0 <br /> �Phone: Phone: <br /> Original Parcel Information <br /> 07-012-2-40-15-11-5 15-711-044000, 045000, 046000,047000 <br /> Parcel ID#: Section 11 Township 40N Range 15W <br /> O <br /> Original Description(or attach copy): Spotted Fawn Add to Voyager Village Lots 34-37 <br /> a <br /> V <br /> e <br /> .6: <br /> la Current Zoning: PUD Floodplain Y/N: N Wetlands Y/N: N Lake/River Class: <br /> aName of Water Body: N/A Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation Y/N:N Managed Forestry Law Y/N:N <br /> 3 <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: CSM to combine lots <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> x <br /> Proposed access to public waters to be provided Y/N: A <br /> If yes,describe access: Ala e <br /> Signature of Owner: is . ---- ,..` Date: / a/ Z°a° <br /> Signature of Owner: 0 Date: /c2-//A— Z O o <br /> 2 <br /> D Does parcel meet Zoning Requirements? Yes No — ‘.0 e- 9 a <br /> N <br /> o D Does parcel require a Surrey? Yes No <br /> 00 00 <br /> o O� <br /> ° X. •" > Permit application fees submitted? 0 Amount$ SCi Receipt# N <br /> W <br /> t 0 Reconciles with Real Property Lister Yes No Date: <br /> tQ 164 <br /> If not,explain: <br /> 2 <br /> Applicatiory Approve Denied Reason for Denial: <br /> Land User •`" / SO?..0 Date: <br />