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1 Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br /> pp Survey of Existing Parcel: $50.00/lot <br /> and/or Pre-Application Form or Map Review Form Subdivision w/Survey: $200.00+$50.00/lot <br /> b <br /> Owner: The T.C. Wilson Family Trust Buyer: Harlo L. Olson. Jr. <br /> Z <br /> Address: 5984 Bushey Road Address: 26876 Lily Lake Inn Road <br /> v) <br /> Webster, WI 54893 Webster, WI 54893 <br /> (715) 553-1118 Phone: (715) 566-0497 R'' <br /> Phone: I <br /> Original Parcel Information 1-11 <br /> Parcel ID#: 07-020-2-40-16-24-4 03-000-011001 Section 24 Township 401\1 Range 16W <br /> O <br /> Original Description (or attach copy): SWA SEA, 24-40-16 except CSM #4229, V.22, P.255 <br /> Current Zoning: A-ZFloodplain YIN: .- Wetlands Y/N: Lake/River Class: s/ !o_ .0....O <br /> D Name of Water Body: Shoreland Agreement/SIPS Y/N: r 7 <br /> .o <br /> r,' Farmland Preservation Y/N: Managed Forestry Law YIN: 0 <br /> , , il <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: The East 20 acres of SWA SEA, 24-40-16 4 <br /> E <br /> Acres: 20 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) 'Z <br /> y <br /> Proposed access to public road: <br /> Proposed access to public waters to be provided Y/N: <br /> If yes, describe access: N <br /> -o <br /> Signature of Owner: ,�G�1,//. 1AJp� . Trustee Date: A — 7-?02-( z <br /> E DE [t IE Date: <br /> Ifi, � <br /> � <br /> 0 Y Does parcel r el et ping Requirements? Yes No <br /> JUN 0 8 2021 E' <br /> I, Does parcel r re a Survey? Yes No <br /> N <br /> 30 <br /> 5� BBmeR�rflt�IDTdlpplication `ees submitted? ❑ Amount$ S�9 C�luh 10 e erpt# <br /> Lan e <br /> ® Reconciles with Real Property Lister .'e No Date: (of C10.•A 2o <br /> t~ <br /> m If not,explain: <br /> m, <br /> F. <br /> Application: • pproved / )enied Reason for Denial: <br /> Land Use: Date: <br /> g <br /> €4A• V- ►grad ' W est" 24 acv f eq ve., e-S cm 341 W <br /> C4 to v9 6us e7 ' w f'1 if - . access ye,u4 eY'P4 S. <br />