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tsurnett t_,ounty �uooivision rermit Application`J PP lees(must accompany form): <br /> and/or Pre-Application Form or MapReview Form Subdivision w/o Survey: $50.00PP Survey of Existing Parcel: $50.00/lot <br /> Subdivision w/Survey: 5200,00+$50.0(Nlot <br /> ,lien Metcail ill <br /> Owner: Buyer: Erik Mewl <br /> e. <br /> Address: 2000 US FiWsf i-, <br /> e. <br /> Address: 21866 MAPLEWOOC B <br /> St. Croix Falls, WI 54024 x <br /> Grantstaur�. Wl 54840 <br /> Si <br /> Phone: 715-768-0094 Phone: " '--1 �P <br /> Original Parcel Information !� <br /> Parcel ID#: -010-2-08 ' ' ' 0;3-00( ,;;-;. Section Township Range 0�0 <br /> Original Description(or attach copy): Lot 2 CSM #48`„�, <br /> vWv4-SW & SE14-SW14 <br /> 3 <br /> Current Zoning: Floodplain Y/N: Wetlands Y/N: Lake/River Class: <br /> Y <br /> v Name of Water Body: Shoreland Agreement/SIPS Y/N: ) <br /> m Farmland Preservation Y/N: Managed Forestry Law Y/N: N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: This is CSM will divide the existing lot %1 <br /> ', lots. Lot 3 is west 5 Acre.; and Lot 2 's rernarit <br /> Acres: s -' t1 A <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> v <br /> Proposed access to public road: m <br /> j ' <br /> Proposed access to public waters to be provided Y/N: U <br /> If yes,describe access: <br /> Signature of Owner: (( ,__ _ Date: 3 (•-- a <br /> n <br /> signature or towner: 5ICIEDWE <br /> 11 =C <br /> i> Does parcel meet Zoning Requirements? Yes No ' `-I <br /> cN ➢ Does parcel require a Survey? Yes No SEP i 4 2021 �/ <br /> `.> Permit application fees submitted? 0 Amount$ 300 , Receipt # CO)1(36-____ <br /> Burnott County <br /> 0 Reconciles with Real Property Lister Yes No Date: Land Services Department l.}.1 <br /> oIf not,explain: <br /> c <br /> 0 <br /> y, Application: pproved I enied Reason for Denial: <br /> Land Use: ' • 00Z Date: <br />