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/ <br /> Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br /> 42:"-)L) <br /> and/or Pre-Application Form Survey of Existing Parcel: $50.00/lot <br /> Subdivision w/Survey: $200.00+$50.00/lot <br /> Owner: PMR Properties LLC Buyer: <br /> Address: 28281 French Rd Address: <br /> Danbury WI 54830 p2 <br /> 0 <br /> v <br /> Phone: Phone: <br /> Original Parcel Information <br /> Parcel ID#: 07-020-2-40-16-20-2 02-000-011000 Section 20 Township 40N Range 16W <br /> Original Description(or attach copy): E 3/4 NW NW Ex CSM V11 P110 <br /> -73 <br /> Current Zoning: RR3 Floodplain Y/N: N Wetlands Y/N:N Lake/River Class: <br /> Name of Water Body: N/A Shoreland Agreement/SIPS Y/N: <br /> rt <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N: N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: CSM divide in 2 parcels <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> Proposed access to public waters to be provided Y/N: :•_ <br /> If yes,describe access: <br /> Signature of Owner: AL „ Date: Iz 2-8 2 Zd <br /> Signature of Owner: Date: (] <br /> a <br /> > Does parcel meet Zoning t!equirements? Yes No ( - 60 ° <br /> N <br /> > Does parcel require a Szt vey? Yes No <br /> > Permit application fees submitted? 0 Amount$ [' De✓0• � lC <br /> Receipt# <br /> m l�Reconciles with Real Property Lister QD No Date: 1/14-i= <br /> a <br /> If not,explain: <br /> 0 <br /> c <br /> ti <br /> Application Approved / II•nied Reason for Denial: <br /> Land Use: Date: // <br /> Pee sur a 3".71-- par �u~� Se/a/ <br /> 71D 4 J/I GJi $0 /70 Cr Gc e $5 Ne-?N/HGd, //7f-- <br />