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• <br /> 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+$50.00/lot <br /> Owner: Dean Phemetton Buyer: b <br /> to <br /> Address:PO Box 462 Address: <br /> Webster WI 54893 <br /> c <br /> Phone: Phone: <br /> l% <br /> Original Parcel Information <br /> Parcel ID ii: 07-018-2-39-16-15-2 03-000-011000 Section 15 Township 39N Range 16W <br /> Original Description(or attach copy): SW-NW 0 <br /> n <br /> V <br /> lc b Current Zoning: Floodplain Y/N: N Wetlands Y/N:Y Lake/River Class: <br /> p Name of Water Body: Shoreland Agreement/SIPS Y/N; 5' <br /> Farmland Preservation YIN:N Managed Forestry Law Y/N:N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: CSM Q <br /> ) <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: C <br /> 0? <br /> Proposed access to public waters to be provided Y/N: <br /> 00 <br /> If yes,describe access: <br /> 4. <br /> Signature of Owner: Date: 1 <br /> Signature of Owner: -CI <br /> Q Date: 5-2-C- Z o <br /> 2 <br /> c <br /> ➢ Does parcel meet Zoning Requirements? Yes No . <br /> is <br /> NI <br /> ➢ Does parcel require a Survey? Yes No <br /> etc <br /> a5* <br /> Permit application fees submitted? 0 Amount$ Receipt# <br /> t ® es Reconciles with Real Property Lister No Date: 7/6,2 I ke2 CJ <br /> b <br /> °' If not,explain: <br /> m <br /> co <br /> 0 <br /> a <br /> Applicatio 1 ' pproved Denied Reason for Denial: <br /> Land Use: U/5/Z/ Date: <br />