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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+$50.00/lot <br /> Owner: Steven Rossow Buyer: ,,y <br /> Address:8502 County Rd D Address: 3 <br /> Webster WI 54893 <br /> 0 <br /> N <br /> Phone: Phone: C <br /> Original Parcel Information (z) <br /> 07-016-2-39-17-24-3 04-000-011000,011100,011200,011300,011400 <br /> Parcel ID#: Section 24 Township 39 Range 17 <br /> Original Description(or attach copy): SE-SW Lots 6-10 CSM V19 P207-213 n <br /> eof <br /> .,7 Current Zoning: RR3 Floodplain Y/N: N Wetlands Y/N: N Lake/River Class: <br /> b <br /> oName of Water Body: N/A Shoreland Agreement/SIPS Y/N: No <br /> Farmland Preservation YIN: N Managed Forestry Law Y/N:N /\ <br /> 0 <br /> New Parcel Information C <br /> Proposed New Legal Description and Parcel Size: CSM divide existing 1J <br /> Acres:40 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: C <br /> a <br /> ii <br /> Proposed access to public waters to be provided Y/N: <br /> 00 <br /> Q\ <br /> If yes,describe access: ,� <br /> Signature of Owner: Date: 7 Th2ZZ`cad--/ <br /> Signature of Owner: Date: a <br /> 5 <br /> ➢ Does parcel meet Zoning Requirements? Yes No c, <br /> NI <br /> ➢ Does parcel require a Survey? Yes No <br /> ora oi O Q <br /> Permit application fees submitted? 0 Amount$ I O© ' Receipt# p4 0 <br /> t es al Reconciles with Real Property Lister No Date: 1-Qct-at <br /> 0 <br /> a- If not,explain: O� 0 <br /> 0 <br /> 4 <br /> ` d oQ <br /> F., <br /> Applicatio Approved / enied Reason.for Denial: <br /> Land Use J/ aOl>/ Date: <br />