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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 Subdivision w/Survev: $200.00+$50.00/lot <br /> Owner& <br /> Owner: Diane Fenn Nelson Trust Buyer: Michael W Hoverman 9 <br /> Address: 22950 County Road Y Address: 2062 122 Ave 3 <br /> Z <br /> Grantsburg, WI 54840 St Croix Falls, WI 54024 kA <br /> G <br /> Phone: 651—248-1396 Phone: 715-491-1927 <br /> Original Parcel Information <br /> r <br /> 4 parcels (continued bdow) <br /> Parcel ID#: Tax ID: 29483 FIN: 07-042-2-38-18-27-5 15-209-037000 Section 2 7&28 Township M Range ,8 -� <br /> O <br /> Original Description(or attach copy): All of lots 1,2,3&4 CSM V19 P213 (#/360155) o <br /> Tax ID: 29484 PIN: 07-042-2-38-18-27-5 15-209-038000 <br /> Tax ID: 29485 PIN: 07-042-2-38-18-27-5 15-209-039000 Being part of Gov't Lot 4 of Sec. 27 <br /> Tax ID: 29486 PIN: 07-042-2-38-18-27-5 15-209-040000 & port of Gov't Lot 1 of Sec. 28 <br /> Current Zoning: ~RI Floodplain Y/N: Wetlands Y/N: <br /> Lake/River Classification: Name of Water Body: (Big) Wood Lake <br /> Shoreland Agreemt or SIPS Y/N: Farmland Preservation Y/N: Managed Forestry Law Y/N: Z <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: Proposed CSM <br /> Acres: <br /> 4.4 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: Cou,jty Rood Y (via existing cur-Irrior7 drive) p <br /> Proposed access to public waters to be provided Y/N: No <br /> If ves,describe access: <br /> N <br /> Signature of Owner: Date: �� d <br /> Signature of Owner: Date: <br /> v <br /> ➢ Does parcel meet Zoning Requirements? Yes No tx--it Zg <br /> 0 4NaL 1�00 ckr#t <br /> ➢ Does parcel require a Survey? Yes No 7219 -3Y, <br /> ° od <br /> 3c 0 <br /> Permit application fees submitted? ❑ Amount$ Receipt# <br /> r ❑ Reconciles with Real Property Lister Yes No Date: X. <br /> a� <br /> 0 <br /> a <br /> If not,explain: <br /> CIO <br /> c. <br /> Application: �pproved Denied Reason <br /> Reason for Denial: <br /> v1 <br /> 0T/ 47 N 491 <br /> AZ <br /> Land Use: / Z Date: <br />