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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+$50.00/lot <br /> Craig & Linda Root <br /> Owner: Buyer: <br /> C <br /> Address: 24090 Malone Rd Address: I. <br /> Siren WI 54872 2 <br /> 715-349-2694 G <br /> Phone: Phone: T' <br /> Ori nal Parcel Information <br /> 07-014-2-38-15-07-5 05-010-013000 P <br /> Parcel ID#: 07-014-2-38-15-07-5 05-010-012000 Section 07 Township 38N Range 15W CN <br /> Original Description(or attach copy): W 1/2 of E 1/2 of GL 10& N 1/2 of W 1/2 of GL 10 4^ <br /> CD <br /> A2 <br /> bCurrent Zoning: Floodplain Y/N: N Wetlands Y/N: N Lake/River Class: <br /> g <br /> o Name of Water Body: N/p` Shoreland Agreement/SIPS Y/N: �` <br /> R• Farmland Preservation Y/N: N Managed Forestry Law Y/N: N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: CSM to combine lots <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: t7 <br /> co <br /> M <br /> Proposed access to public waters to be provided Y/N: •D` <br /> If yes,describe access: \\\ <br /> Signature of Owner: Date: (,i9/>77/, .9 <br /> Signature of Owner: Date: o <br /> 2 <br /> > Does parcel meet Zoning Requirements? Yes No m <br /> aN ➢ Does parcel require a Survey? Yes No <br /> °0 > Permit application fees submitted? IDAmount$ Receipt# <br /> n 0= Reconciles with Real Property Lister CID No Date: (a- A- a <br /> a <br /> =. If not,explain: <br /> CD <br /> n <br /> 1 <br /> o <br /> r. <br /> n CY1 <br /> Applicatio•. •pproved Denied Reason for Denial: <br /> Land Use: IYZO0/Z,2-'bste: <br />