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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> Subdivision w/o Survey: $10.00 <br /> and/or Pre-Application Form Subdivision w/Survey; $25.00+$5.00/lot <br /> Owner: <br /> Address: Thomas W Haines <br /> °.+ PO Box 527 <br /> Siren WI 54872-0527 <br /> Phone: � /,5- ;�411 - 5-&5o <br /> Ori¢inal Parcel Information <br /> 3 <br /> Parcel Identification #: bD 1� o1 4// O a Section I Township 0 Range d z <br /> Original Description (or attach copy): /V&V S OJ CSX /V.336 <br /> SD <br /> O <br /> Current Zoning: Floodplain Y/N: > T Wetlands Y/N: 1 I <br /> o <br /> Lake/River Classification: <br /> q� <br /> A"O Name of Water Body: <br /> d <br /> 0 <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: <br /> Acres: <br /> A <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: 1�& <br /> Proposed access to public waters to be provided Y/N: <br /> A <br /> If yes,describe access: <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> N ���� <br /> °o ➢ Does parcel require a Survey? Yes ,/No J $53b a c <br /> o � ( 3 <br /> 00 <br /> ➢ Permit application fees submitted? Amount$ J0ei.Z Recei t# � <br /> trw- <br /> c <br /> I ?� O <br /> ❑ Reconciles With Real Property Lister Yes No Date: 4 3 O <br /> a <br /> If not,explain: �� x,_isz. Ck-4 —�VI-0-. �� �('� t C C'o 1 I �. <br /> o <br /> a � 2 <br /> N <br /> N <br /> Application: Approve / Denied Reason for Denial: <br /> Land Use: Date: <br /> 2/18/2003 <br />