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Burnett County Subdivision Permit Application I c,::onus(ac,,un(,II (vrnl: <br /> �, ligation Form or MapReview Form S"(„'"i'i"""/`1Survey. S50.0(I <br /> and/Or' Pre-Application Survey of I'xi;ting Part:cl: 1)50.00.1 d <br /> Subdivision kV'SiIIATV: 9i3(I(l,(Ill i Sii1.(5)ha <br /> Owner: BRU cE.allEe ANNA !Inver: <br /> JIi4S' i oM REV 1Bus-r" . <br /> lcidress:�L2:7 t ` �06t)'_kK � Address: "' <br /> 3l(2C-N WI54872- <br /> 117 <br /> Phone: 715-566-07 35 Phone: <br /> u <br /> Original Parcel information <br /> Parcel ID#: 2a6852 WGEk Section 31 Township 38 Range (6 _ :" <br /> Original Description (or attach cop}): <br /> Lotsf & 2 CSuo. 2122v 12 p 3G-37 <br /> Current Zoning: RR-1 Floodplain[ 1'/N: Y Wetlands 1'/\: � Lake/River Class: N <br /> /A <br /> -o Name of Water Body: �9 �� Shoreland Agreement/SIPS Y/N; N <br /> ,��, Farutland Preservation Y/N: N Managed Forestry Law Y/N: N <br /> New Parcel information <br /> Proposed New Legal Description and Parcel Size: (his !•g C CM re conelures e(O -Lh 4i <br /> beer, lo-f4 f 2 2 <br /> Y <br /> Acres: 2.56E 2.1634 A <br /> (If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br /> Easement.ex{etnds easF and 'ocrt to S E lb ow Lake 12 tom/ <br /> Proposed access to public road: m <br /> Proposed access to public waters to be provided Y/N: N �� <br /> Ifyes, describe access: <br /> 1 C/ <br /> Signature of Owner: -. Date: �, <br /> i <br /> .>1gnature of UWner: wale: F. <br /> v <br /> C <br /> '. Does parcel meet Xiaiing Ici uirc inciat,c:' Yes IV,, !�#/7?3 <br /> It <br /> floes parcel require a.Siirvcfl.' '( '.c rho 5(j <br /> 0 <br /> Permit af)p/!e'anou tressubmitted) ❑ ..11n oint.S' /D. Receipt ! <br /> TC <br /> ❑ Reconciles with Real Property Lister Yes No Date: <br /> , it•not,explain: <br /> z <br /> r, <br /> r. <br /> 6. Application. Approved / Denied Reason for Denial: 6 <br /> I.and Use: ���zX Dale: <br />