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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/Survey: $200.00+$50.00/lot <br /> Owner: Daniel Flodin/Flodin Construction, LLC Buyer: .: <br /> ft <br /> g. <br /> Address: PO Box 141 Address: <br /> Siren, WI 54872 P <br /> 0 <br /> iA <br /> Phone: Phone: <br /> 72 <br /> Original Parcel Information Q <br /> Parcel ID#: 07-006-2-38-17-24-1 04-000-014000 Section 24 Township 38N Range 17W k <br /> Original Description(or attach copy): S 660' of SE NE EXE 990' OX-) <br /> ron <br /> d <br /> = Current Zoning: A2 Floodplain Y/N: N Wetlands Y/N: N Lake/River Class: - ns <br /> Name of Water Body: - Shoreland Agreement/SIPS Y/N: N <br /> Farmland Preservation YIN: N Managed Forestry Law Y/N: N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: New 1 lot CSM of existing parcel to document <br /> easements. <br /> Acres:4.5 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: u <br /> y <br /> n <br /> Proposed access to public waters to be provided YIN: "l>1 <br /> ,\ <br /> If yes,describe access: <br /> Signature of Owner: /02/l/,CC/'- Z'l Date: � / <br /> Signature of Owner: Date: rc <br /> C <br /> Does parcel meet Zoning Requirements? Yes No <br /> N * <br /> o > Does parcel require a Survey? Yes No <br /> 5' <br /> °Q > Permit application fees submitted? ❑ Amount$ Receipt# <br /> r Reconciles with Real Property Lister Yes No Date: <br /> 0 <br /> c If not,explain: <br /> 9, I d — <br /> Application: Approved / Denied Reason for Denial: )I I 1r1 2 6 zrro ji <br /> 3lz07 <br /> Land Use: /r/` Date: <br /> It <br /> C'_14PtObC-) 1 50 <br />