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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> and/or Pre-Application Form or Map Review Form Subdivision w/o Survey: $50.00 <br /> Survey of Existing Parcel: $50.00/lot <br /> Subdivision w/Survey: 5200.00+550.00/lot <br /> Owner: Grace Haines Buyer: Carolina Calixto-Rosas <br /> f.P.,. <br /> Address: PO BOX 3 Address: <br /> SIREN WI 54872 z <br /> 0 <br /> 01 <br /> Phone: Power of Attorney: Fred Haines 715-222-3244 Phone: �J <br /> Original Parcel Information <br /> Parcel ID#: 07-030-2-38-16-04-5 05-003-011001.gection 4 Township 38 Range 16 <br /> Original Description(or attach copy): <br /> Government Lot 3 except E 415' OF N 265' ep <br /> ep <br /> & EX PCL 11 TPP V6 P320 <br /> C-1N/A 3 <br /> Current Zoning: Floodplain Y/N: N Wetlands Y/N: Y Lake/River Class: A <br /> v Name of Water Body: Shoreland Agreement/SIPS Y/N: N <br /> VI <br /> to <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N: tC` <br /> New Parcel Informationopl <br /> Proposed New Legal Description and Parcel Size: This CSM creates new lot. <br /> O <br /> to <br /> Acres: 4.00 Acres <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Direct access to STH 70 as shown on CSM d <br /> Proposed access to public road: " <br /> n <br /> Proposed access to public waters to be provided Y/N: N �� <br /> If yes,describe access: <br /> Signature of Owner: N/A Date: <br /> n <br /> signature of owner: Date: c <br /> e <br /> > Does parcel meet Zoning Requirements? Yes No ac / "/(L 7' K <br /> N <br /> ➢ Does parcel require a Survey? Yes No <br /> TCA <br /> o )%' Permit application fees submitted? 0 Amount$ Z 72 Receipt# <br /> 0 Reconciles with Real Property Lister Yes No Date: S <br /> toIf not,explain: <br /> a <br /> es <br /> et0 <br /> a, Application: Approved / Denied Reason for Denial: <br /> Land Use: I I 'z113 <br /> w ,lam Date: <br />