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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/Survev: $200.00+$50.00/lot <br /> Owner: Ted M & Kelly S Gerber Buyer: John W & Tammy K Ingalls Revocable <br /> Living Irust A <br /> Address: 24636 N. Fosstm Rd Address: 27167 Engebretson Rd 3 <br /> z <br /> Grantsburg, WI 54840 Webster, WI 54893 <br /> Phone: 715/689-3429 Phone: 715/866-4271 <br /> S <br /> Original Parcel Information ,9.J <br /> Parcel ID#: 042-2501-02 100 Section 01 Township 38N Range 18W <br /> Original Description (or attach copy): SE 1/4 NW 1/4, Sec. 01-38-18, Burnett County WI. <br /> A <br /> Current Zoning: LGi/zp( DFloodplain Y/l�/ Wetlands YIN: Lake/River Class. <br /> — <br /> > Name of Water Body/� Shoreland Agreement/SIPS YCN. <br /> m Farmland Preservation Y/N: Managed Forestry Law Y/N: <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: N 1/2 SE 1/4 NW 1/4, Sec. 01-38-18, <br /> Burnett County, WI. <br /> Acres: 20 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> O <br /> Proposed access to public road: North Fosstm Road d J <br /> m � <br /> Proposed access to public waters to be provided Y/N: Aj <br /> If yes,describe access: A 9J <br /> Signature of Owner: Date: <br /> 03 <br /> n <br /> Signature of Owner: Date: <br /> 3 <br /> )0 Does parcel meet Zoning R quirements? Yes No atf 70- f� G <br /> ➢ Does parcel require a Survey? Yes No <br /> °0 ➢ Permit aPPlicationfees submitted? Amount$ <br /> Receipt# 9.1 <br /> d <br /> mReconciles with Real Property Lister Yes No Date: © G' <br /> If not,explain: d <br /> n <br /> a (p <br /> y \ v <br /> Applicatio Approved / Denied Reason for Denial: <br /> Land Use: Date: <br />