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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+$50.00/lot <br /> Owner: Jensen Anderson Buyer: <br /> b <br /> eD <br /> Address: 11422 North Shore Dr Address: <br /> Grantsburg WI 54840 0 <br /> Phone: Phone: Q� <br /> tv <br /> Original Parcel Information W <br /> k' <br /> Parcel ID#: 07-042-2-38 18 27 5 15-395-015000 Section 27 Township 38N Range 18W <br /> Original Description(or attach copy): Klem's Wood Lake View Add Lot 3 Blk 1 <br /> a <br /> to <br /> 4— <br /> CurrentRR1 N Zoning: Floodplain Y/N: Wetlands Y/N: N Lake/River Class: <br /> v <br /> m Name of Water Body: N/A Shoreland Agreement/SIPS Y/N; <br /> a <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N: N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: 2 lot CSM <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: North Shore Dr ty <br /> Proposed access to public waters to be provided Y/N: N <br /> If yes,describe access: 4 / 1 t.,A\ <br /> irAler <br /> . �.�.—. �i��� Date: �Z '3 <br /> - <br /> Signature of Ow 1, Date: c <br /> a <br /> b <br /> > Does parcel meet Zoning Requirements? Yes No .-60 € ------ ° <br /> N � <br /> a ➢ Does parcel require a Survey? Yes No <br /> 1. <br /> °q > Permit application fees submitted? 0 Amount$ 3 00'D Receipt# <br /> TX <br /> c.)st <br /> m I2I Reconciles with Real Property Lister ® No Date:a-8-d3 W <br /> a <br /> n. If not,explain: <br /> n <br /> o <br /> 0 <br /> Co <br /> GO <br /> Applicatio enied Reason for Denial: <br /> Land Use: 9 z0 z 3 Date: <br />