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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: S50.00/lot <br /> and/or Pre-Application Form Subdivision w/Survey: $200.00+$50.00/lot <br /> Owner: Gary Marek Buyer: .0 <br /> A <br /> Address: 23362 Brown Road Address: i <br /> Grantsburg, WI 54840 °stf) <br /> Phone: 715-222-1879 Phone: a <br /> au <br /> Original Parcel Information <br /> 0 <br /> Parcel ID#: Tax ID: 4212 PIN: 07-010-2-38-19-17-3 04-000-011000 Section 1 7 Township 38 Range 19 <br /> Original Description(or attach copy): <br /> r <br /> n <br /> SE1/4—SW1/4-17-3819, EXCEPT LOT 1 CSM V 2 P 240, ALSO EXCEPT OUTLOT A CSM V 3 P 97 <br /> Current Zoning: A2 Floodplain Y/N: Wetlands Y/N: <br /> Lake/River Classification: Name of Water Body: <br /> Shoreland Agreemt or SIPS Y/N: Farmland Preservation Y/N: Managed Forestry Law Y/N: <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: Proposed CSM <br /> Acres: 33.6± <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: Soderbeck Road d <br /> m <br /> Proposed access to public waters to be provided Y/N: '.9 <br /> If yes,describe access: <br /> Signature of Owner: i 4W2F Date: -,? 'a1-1- <br /> 4111,Signature of Owner: _ .Arhr.. Date: 7' �� ---` o <br /> Or b <br /> > Does parcel meet Zoning Requirements? Yes No .i <br /> /Z. <br /> "i <br /> 1. ➢ Does parcel require a Survey? Yes <br /> No G!�' <br /> as �p <br /> > Permit application fees submitted? 0 Amount$ 300, r Receipt# j <br /> m 0 Reconciles with Real Property Lister Yes No Date: <br /> a <br /> a <br /> If not,explain: <br /> 0 <br /> ti <br /> Li. <br /> Ap lica ' . A roved)enied Reason for Denial: <br /> VS/7-0 241 33 'lc-4 ►n = 3 c, 'fs q/s.q 3 ///5 <br /> and Use: ��// �] Date: <br /> 7A15 /S Li Of? &e. De v4S/1 9&t/fi lt7Pt " Ar 'viol 16/Z can be Selt ',Ht room,44Afe.. <br />