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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision win Sur cy_ $sa.00 <br /> Survey of Existing Parcel: $50.00/lot <br /> and/or Pre-Application Form Subdivision w/Survey: $200.00+$50.00/lot <br /> Owner <br /> owner; Ken Kreb : Kathy Bross <br /> Address:P0 Bax 628 Address: 887 VJobi Trail <br /> Siren WI 64872 Amery WI 54001 <br /> Cia <br /> Phone:. 715-349-5294 Phone: <br /> Original Parcel Information <br /> Parcel ID#: 07-030-2-38-t6-23-3 01-000-013000&014000 Seddon 23 Township 38N Range 16W <br /> Original DescDescription. W 601Y(or attach copy): NE-SW <br /> Current Zoning: A2 .Floodplain Y/N; N Wetlands Y/N:N Lake/River Class: <br /> 2 Name of Water Body; Shoreland Agreement/SIPS Y/N <br /> Farmland Preservation Y/N:N Managed Forestry Law Y/N:N <br /> New Parcel Information �C " <br /> Proposed New Legal Description and Parcel Size: CSM <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached.forpreliminary map requirements.) <br /> Proposed access to public road: tZ <br /> Proposed accessto public waters to he provided Y/N: <br /> If yes,describe access: <br /> Signature of Owner: hate: 2 d <br /> Signature of Owner , Date: 0 57.2V/a„o; <br /> Does parcel meet Zonptg Requirements? Yes No <br /> a `F .Does parcel require a Surrey? Yes No <br /> tf0 > Permit application fees submitted? ElAmount$ / 00 e;:j2 Receipt.# <br /> CA <br /> WI Reconciles with Real Property Lister (e No Date: l0/abial w <br /> If not,explain: ..IY).,. <br /> a O <br /> UI . <br /> N <br /> Ap ca= ed ,Denied Reason fa Denial: <br /> d + zo <br /> s ^_ <br /> tc- <br />