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Fees (must accompany form): <br />Burnett County Subdivision Permit Application Subdivisionw/oSurvey: $50.00 <br />Survey of Existing Parcel: $50.00l1ot <br />and/or Pre -Application Form Subdivision w/ Survev: $200.00 + $50.00/lot <br />Duane V. & Cheryl L. Johnson and <br />Owner: Gary S. & Jane C. Bell Buyer: Gary S. & Jane C. Bell <br />Address: 12304 County Road D Address: 12324 County Road D <br />Grantsburg, Wl 54840 Grantsburg, WI 54840 <br />Phone: 715-463-2750 Phone: 715-463-2559 <br />Original Parcel Information <br />Parcel ID #: 07-042-2-38-18-05-4 02-000-011000 Section 05 Townshi 3p 8 N Range 18 W <br />Original Description (or attach copy): See attached: Addendum A <br />-Z aH�u�zoN <br />Current Zoning: Floodplain Y/N: N/A Wetlands YIN: _N/A Lake/River Class: N/A <br />Name of Water Body: <br />Shoreland Agreement/SIPS Y/N: <br />Farmland Preservation Y/N: N/A Managed Forestry Law Y/N: N/A <br />New Parcel Information <br />Proposed New Legal Description and Parcel Size: See attached: Addendum B <br />Acres: <br />(If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Proposed access to public road: Access through property already owned by owners <br />Proposed access to public waters to be provided Y/N: <br />If yes, describe access: <br />Signature of <br />Signature of Owner: �c+� 5y tp <br />➢ Does parcel meet Zoning Requirements? <br />➢ Does parcel require a Survey? <br />➢ Permit application fees submitted? ❑ <br />❑ Reconciles with Real Property Lister <br />If not, explain: <br />Application: Approved / enied <br />.�%ltrtSon Gay' �W�sf <br />Land <br />PAN <br />'e,L---l.e: �41 7 // <br />&6'Date: T�� Cj <br />Yes No <br />Yes No � ,, � 1 �„� <br />Amount $ Q .� Receipt # <br />Yes No <br />Reason for Denial:_ <br />orAioa of Z;x <br />?10CY m u sf z e_ <br />Date: lIleAc l 9 <br />