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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: $200.00+$50.00/lot <br /> Owner: GK Talmadge Trust Buyer: Rick Anderson g B <br /> CV R <br /> 7803 Tewalt Rd 9222 County Line Rd o <br /> Address: Address: <br /> Siren WI 54872 Siren WI 54872 0 (/' <br /> N <br /> Phone: Phone: c 'A <br /> Original Parcel Information &.' `� <br /> Tax ID#: 07-030-2-38-16-19-5 05-003-011000 Section__19 Township 38 Range 16 --.- <br /> O <br /> Original Description(or attach copy):GL3 g <br /> N <br /> ,..g r <br /> Current Zoning: A2 Floodplain Y/N:Y Wetlands Y/N: Y Lake/River Class- <br /> Name of Water Body:Clear Lake Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation Y/N:N Managed Forestry Law Y/N: N <br /> New Parcel Information \ <br /> 2 Lot CSM 8 , <br /> Proposed New Legal Description and Parcel Size: 3 <br /> Acres- <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: E <br /> Proposed access to public waters to be provided Y/N: g <br /> 0 16. <br /> If yes,describe access: W <br /> 00t <br /> : <br /> W• K <br /> 00 <br /> > Does parcel meet Zoning Requirements? Yes No Fee Rec: 3/Ot �/ <br /> Check#: ./O6, / <br /> > Does parcel require a Survey? Yes No <br /> Reconciles with Real Property Lister Yes No Date: <br /> If not,explain: <br /> Application Approved / enied Reason for Denial- <br /> Land U : Date: <br /> �,-.—� /o zy zo z`{ <br /> er� no/e- *4 1 Olt Vie' C1, cke74ix7 ti 10/1c-ei5 q/o )/ <br /> 'HIE- lam 1n 1 are-g, <br /> 0dlo s Ile/ ie o/� i0 rm //y and A <br /> he Sala 5 / gr47?2 o DG / 5Aou /a/ qo w/'4 78'88" T�wa// &d <br /> OG 2. 54.4 id re wN-4 7 8'•3s T t.,)4/74. Rc✓ <br />