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Fees {mu,t accompany form): <br />Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br />Survey of L-xisting Parcel: S50.00,1ot <br />and/or Pre -Application Form subdivision W. Survcv: S200.00 $50.00/l„t <br />K -Wood Truss Rafters, inc. <br />Owner: Alr,c KareIs c/o Cynthia Leonard ('— <br />'ro <br />Address: 22131 Spirt Lake Rood E Address: 23368 Little iVood Lake Road <br />Frederic, WI 54837 <br />Phone: -f�gc %502 <br />Grontsburc, Wi 54840 <br />Phone: 1 _-689-2503 <br />Oriainal Parcel Information <br />07-042-2-38-18-24-3 02-000-012000 <br />Parcel ID#: 07-042-2-38-18-24-3 02-000-013000 Section 24 <br />Township 38 Range 18 <br />Original Description (or attach copy): See Doc. ##406385 and <br />406384 <br />Current "Zoning: Ur zon ed Floodplain YIN: <br />Wetlands YIN: <br />Lake/River Classification: Name of Water Body: <br />Shoreland Agreemt or SIPS YIN: Farmland Preservation Y/N: <br />Managed Forestry Law YIN: <br />New Parcel Information <br />Proposed New Legal Description and Parcel Size: Lots 1, Proposed CSM <br />Acres: 7.9 2 o c <br />(If parcel is to be surveyed, provide preliminary map. See attached for <br />preliminary map requirements.) <br />Proposed access to public road: Littie Wood Lake Rcad <br />Proposed access to public waters to be provided YIN: <br />If ves, describe access: <br />Signature of O Date: <br />Signature of Owner: Date: y <br />Y Does parcel meet Zoning Requirements? Yes No <br />Does parcel require a Survey' <br />Ycs• :'Vo <br />% Permit application fees submitted? ❑ ftmourtl $ Receipt # <br />❑ Reconciles with Real Property Lister Yes No Date:_ <br />If not, explain: <br />Land L' <br />Reason for Denial: <br />Zo/2 Date: <br />IQ <br />