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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+$50.00/lot <br /> Owner: Duley Ventures Properties LLC Buyer: ,b <br /> ft <br /> Address: 1627 50th St Address: g <br /> Somerset WI 54025 A4 <br /> ..0 <br /> Phone: Phone: L <br /> Original Parcel Information <br /> t <br /> Parcel ID#: 07-012-2-40-15-35-5 05-006-021000 Section 35 Township 40N Range 15W C <br /> I Gov Lot 6 P <br /> Original Description(or attach copy): Pc <br /> 6. <br /> F <br /> cn <br /> Current Zoning: RR1 Floodplain Y/N: Y Wetlands Y/N: N Lake/River Class: <br /> iv* t Name of Water Body: Mallard Lake Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation YIN: N Managed Forestry Law Y/N:N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: CSM <br /> 3, <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> o <br /> m <br /> T <br /> Proposed access to public waters to be provided Y/N: fD <br /> If yes, describe access: <br /> „ry;. airoa�zo21 (� <br /> Signature of Owner: )ctieoy`j/�(Puiperiticc��' -,,;''.-= Date: 11.41 AM CST b/ <br /> Signature of Owner: Date: o <br /> g <br /> b <br /> o <br /> Zoning Requirements? de ‘D3l 7 et <br /> > Does parcel meet Re uirements. Yes No <br /> -s <br /> N <br /> o D Does parcel require a Survey? Yes No <br /> 5' ocia <br /> °° 50 r> Permit application fees submitted? ❑ Amount$ <br /> Receipt# O <br /> Vial6` <br /> � � CM with Real Property Lister No Date: <br /> 5 <br /> a' If not,explain: <br /> 0 <br /> 5- <br /> Application: Approved I enied Reason for Denial: <br /> Land Use: I Z Date: <br />