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Pro boos,acrnnipany fonN: <br /> N Burnett County Subdivision Permit/Survey Review 50,00 <br /> surccy of Gzizling Pwccl: 35000/lel <br /> Application and/or Pre-Application Form snwn,isi„a wrs rnen: suaaa,WWII <br /> Owner: David K & Lois L Edaburn Buyer: David K & Lois L Edaburn <br /> ay on Karen Jorgensen ayton Karen orgensen <br /> Address: Eda urn: 23167 Oty Rd M Address: Jorgensen: 725 W Olson Drive <br /> L <br /> Grantsburg, WI 54840 Grantsburg, WI 54840 <br /> Phone: 715/689-2357 Phone: 715/463-5725 ` <br /> Original Parcel Information ,} <br /> Parcel [B#: 034-1517-01 100 Section 17 'Township 37N Range 18W <br /> f E 330''660oo <br /> Original Description(or attach copy): NE NE ER S � <br /> Current Zoning: Floodplain YIN: % Wetlan s Y : Lake/River Class: <br /> 2+ Name of Water Body: IJP Shoreland Agreement/SIPS YlN� <br /> Farmland Preservation Y/N: Managed Forestry Law Y/N: <br /> New Parcel Information � <br /> Proposed New Legal Description and Parcel Size: See Attached2Addendtrn A <br /> Acres: 17.46 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: State Road 48 C <br /> G <br /> Proposed access to public waters to be provided YIN: ' <br /> If yes,describe access: <br /> Signature oP Owner: ;�`^ Date, <br /> I I IDS L <br /> u Signature of Owner: <br /> J ­ <br /> - <br /> ___ _. . _ seen & Kanah M a I <br /> DK To .S rrr � Or'r`�-L o <br /> r Does panel meet Zoning Reyuireneents? Yes No I <br /> �, a 1 <br /> > Does parcel require o Sune�'? Yes sNOJ �y J <br /> r Permit application fret submitted? K Amount e 5Q° Receipt N fXL1 <br /> I <br /> [],Reconciles with Real Property Lister Yes No Date, I I Z.��U l� <br /> If I not,explain: <br /> z � <br /> o <br /> a a <br /> Applicati nom: .Approved nied Reason for Denial:- <br /> Land Use: Date: <br />