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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 or Map Review Form Subdivision w/Survey: S200.00+$50.00/lot <br /> E <br /> Owner: AsitteRanta Buyer: A i <br /> Address:25199 Lakeview Rd Address: A o <br /> Siren WI 54872 C. <br /> Phone: 101 2 -3?& / i .5 Phone: 111 <br /> Original Parcel Information c <br /> Tax m#: 07-018-2-39-16-34-5 15-473-018100 Section 34 Township 39N Rye 16W <br /> Original Description(or attach copy):Mound Beach Lots 1-4 Bik 2 & N 1/2 vacated 1st St <br /> O <br /> 1 <br /> A <br /> Current Zoning: RR1 Floodplain Y/N:N Wetlands Y/N: N Lake/River Class* <br /> Name of Water Body:N/A Shoreland Agreement/SIPS Y/N: <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: -no pi, i 1>"Tr)(...AN.) /Z.c)AD <br /> d <br /> Proposed access to public waters to be provided Y/N: N <br /> If yes,describe access: �w Q 1'1/,,�► //�, <br /> Signature of Owner: Y ► ' t.'^'► Date: —2-1-`�j <br /> Signature of Owner: Date: OB <br /> Fee Rec: i� <br /> ➢ Does parcel meet Zoning Requirements? Yes No 4. Check#: /9893 <br /> ➢ Does parcel require a Survey? Yes No 1 <br /> r <br /> 8 <br /> y <br /> ro <br /> Reconciles with Real Property Lister Yes No Date: S <br /> If not,explain: <br /> 0 <br /> Applicatio 'ed Reason for Denial: <br /> ai <br /> Land U / Ci Date: <br />