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Fees( ust accompany <br /> m): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey�n$50.00 <br /> and/or Pre-A lieation Form Survey of Existing Parcel: $50.00/lot <br /> pp Subdivision w/Survey: S200.00+$50.00/lot <br /> Owner: Mitch Ryan Buyer: <br /> b <br /> Address: 23622 Larson Road Address: a <br /> Grantsburg, WI 54840 0 <br /> cii <br /> Phone: 715-222-7569 Phone: e <br /> CO <br /> Original Parcel Information <br /> Parcel ID#: 07-010-2-38-19-16-4 03-000-014000 Section 16 Township 38 Range 19 N <br /> oQ <br /> Original Description(or attach copy): <br /> 07-010-2-38-19-16-4 03-000-013000ei <br /> Legacy#: 010261603600 Tax ID#: 4180 See Doc.#281082 :' <br /> LLe0ga t 010261603610 03-000-014000ax1 # 1See Doc.#254461 32 <br /> a Current Zoning: A2 and Cl Floodplain Y/N: Wetlands Y/N: <br /> Lake/River Classification: Name of Water Body: Hay CreekcZCI <br /> Shoreland Agreemt or SIPS Y/N: Farmland Preservation Y/N: Managed Forestry Law Y/N: <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: Proposed CSM <br /> Lot 1 (1.35 Acres±) <br /> Lot 2 (10.46 Acres±) Lot 3 (6.49 Acres±) <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Lot 1 - Existing driveway on State Highway No. 70 <br /> Proposed access to public road: Lots 2 and 3 - Existing driveways wesf to Larson Rood C <br /> a <br /> Proposed access to public waters to be provided Y/N: N <br /> If yes, describe acc.:.;iimah <br /> t <br /> Signature of Owne , , ,,,e,.. Date: rk <br /> rit,e <br /> NSignature of Owner: Date: /ô / - (( S' P <br /> i3 <br /> "O <br /> Does parcel meet Zoning Requirements? Yes No 6/6-- Z 3 0/ .. <br /> et <br /> a 9 Does parcel require a Survey? Yes No <br /> a �G� 11/ZI�T.dZO <br /> )> 7 Permit application fees submitted? 0 Amount$ vOt�- Receipt# °61 <br /> C 0 Reconciles with Real Property Lister Yes No Date <br /> a. <br /> °v <br /> a <br /> gF If not,explain: <br /> e) <br /> a <br /> N <br /> ApplicatiosCApprove Denied Reason for Denial: <br /> SPS-_ Ac.zoa4 //'4 .p ,,-A' i G— <br /> m <br /> Land Use: ,,1•1111. aa Date: <br />