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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: North Camp Properties Buyer: .b <br /> A <br /> Address: PO Box 66 Address: <br /> Danbury WI 54830 k11 <br /> C <br /> Phone: Phone: i <br /> Original Parcel Information t <br /> Parcel ID#: 07-038-2-41-14-16-5 05-006-011000 Section 16 Township 41N Range 14W <br /> 0 <br /> Original Description(or attach copy): PcI in Gov Lot 6 $ 7 <br /> aN <br /> w Current Zoning: RR1 Floodplain Y/N:Y Wetlands Y/N: Lake/River Class: <br /> Its <br /> a Name of Water Body: Webb Lake Shoreland Agreement/SIPS YIN: 't <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 <br /> Acres: <br /> I' <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: p <br /> m <br /> Proposed access to public waters to be provided YIN: 00` <br /> If yes,describe access: <br /> Signature of Owner: .XY6 4 I/AV Date: !-(S'20'1 / <br /> Signature of Owner: Date: 0 <br /> 3 <br /> v <br /> > Does parcel meet Zoning Requirements? Yes No cki 139'6 0 z-(C. F.a <br /> N 4t <br /> 0 > Does parcel require a Survey? Yes No <br /> a <br /> > Permit application fees submitted? IDAmount$ Q1 Receipt# <br /> O <br /> l31 Reconciles with Real Property Lister Yes No Date:,�/4/ p J <br /> a 7 <br /> °' If not,explain: <br /> X <br /> 00 <br /> 0 <br /> O <br /> Z <br /> a. <br /> . <br /> Application,z--Approved / enied Reason for r Den'al: <br /> 1 0l 07-14clll 9 / SS� 1 C�l4/�� l 20E/0 <br /> Land Use: ..-1.4-c.-- Z" 9/7-e N Date: <br />