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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+$50.00/lot <br /> Owner: Alan EllefSon Buyer: b <br /> eD <br /> Address:28571 Half Moon Trail Address: <br /> 2 <br /> Danbury WI 54830 °(-)) <br /> c <br /> Phone: 715 888 2713 Phone: <br /> I <br /> Original Parcel Information kj <br /> Parcel ID#: 07-012-2-40-15-13-5 15-270-037000, 038000 Section 13 Township ON Range 15W Cj <br /> Original Description(or attach copy): Half Moon Add to Voyager Village Lot 27 & 28 <br /> .t Current Zoning: PUD Floodplain Y/N: N Wetlands Y/N: N Lake/River Class: m <br /> Name of Water Body: NSA Shoreland Agreement/SIPS Y/N: <br /> 00 <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N:N 0 <br /> 3 <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: CSM to combine lots <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: t7 <br /> a <br /> Proposed access to public waters to be provided Y/N: •N <br /> If yes,describe access: <br /> Signature of Owner: 44ii,Z 4f/`� ^ f L Date: Dec. 14, 2020 <br /> ste <br /> Signature of Owner: Date: 3 <br /> a <br /> a <br /> ➢ Does parcel meet Zoning Requirements? Yes No c* G 0 3 0 d e <br /> It <br /> 0 Y Does parcel require a Survey? Yes No <br /> O <br /> °fQ > Permit application fees submitted? 0 Amount$ co �� Receipt# <br /> ‘.Tt <br /> t.. 51 Reconciles with Real Property Lister G No Date: i 2_f /e).6 <br /> a <br /> a <br /> C. If not,explain: <br /> n <br /> o <br /> 0 <br /> a <br /> Application Approved Denied Reason for Denial: <br /> Land Use: /000 7.40 Date: <br />