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i <br /> Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: S50.00 <br /> Survey of Existing ParceL S50.00/lot <br /> and/or Pre-Application Form or Map Review Form Subdivisionw�Sumer 5200.00+s5o.00a0t <br /> V <br /> Timothy Shimko Buyer: Mark Goheen <br /> mo <br /> Owner: Y <br /> 1521 Timber Edge Dr a <br /> Address:1121 37th St Address: ;? o <br /> Hudson WI 54016 McKinney Tx 75072 c <br /> N <br /> Phone: Phone: . <br /> Orfidnal Parcel Information d <br /> Tax ID#: 07-026-2-39-15-28-5 05-003-025000 Section 28 Township 39 Range 15 <br /> 07-026-2-3915-28-5 05-003-026000 <br /> Original Description(or attach copy): GL 3& Lt 1 CSM V20 P255 <br /> H l <br /> a 1, <br /> o <br /> Current Zoning: RR1 Floodplain.Y/N:Y Wetlands Y/N:Y LakeMver Class- <br /> Name of Water Body:Big Sand Lake . Shoreland Agreement(SIPS Y/N: y <br /> v, <br /> ' Farmland Preservation Y/N:N Managed Forestry Law YIN: N <br /> z, <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: CSM G <br /> 0 <br /> m <br /> Acres- <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) k <br /> Proposed access to public road: <br /> Proposed access to public waters to be provided Y/N: 'J <br /> � v <br /> If yes,describe access: .� <br /> Signature of Owner.• <br /> Date• <br /> Signature of Oiruer: D$ ' <br /> Fee Rec: <br /> 9 Does parcel meet Zoning Requirements? Yes No Check#: /O <br /> ? Does parcel require a Survey? Yes No <br /> Reconciles with Real Property Lister Yes No Date: <br /> If not,explain: <br /> Application• Approv enied Reason for Denial- <br /> La e• Date: <br /> n. ,eP a �/0/(411 !mI4 G,��71�/ �S e S 7% S i zG o <br /> h e,a lof 3 so closer A Gd A 4;vr^/H , <br /> y <br />