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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+$50.00/lot <br /> owner: Douglas Plath Buyer: PVI <br /> A <br /> Address:7165 Gables Rd Address: I. <br /> Webster WI 54893 P <br /> Phone: 715-866-8350 Phone: G'KP <br /> Original Parcel Information <br /> i <br /> ped lD#: 07-036-2-40-17-35-4 01-000-011000 Section 35 Township 40N Range 17W `— <br /> original Description(or attach copy): NE-SE ex S 495' of N 990' <br /> :,. <br /> bCurrent Zoning: A7 Floodplain Y/N: N Wetlands Y/N:Y Lake/River Class: r-- <br /> o Name of Water Body: NSA a <br /> Shoreland Agreement/SIPS Y/N; <br /> r. <br /> Farmland Preservation Y/N:N Managed Forestry Law YIN:N '0 <br /> c-- <br /> New Parcel Information i• <br /> Proposed New Legal Description and Parcel Size: CSM divide existing lots r <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: G <br /> o <br /> Proposed access to public waters to be provided Y/N: '° <br /> If yes,describe access: <br /> Signature of Owner:_:_ ____J4‘2u/`---(- Date: . 33 <br /> Signature of Owner: Date: o <br /> 9 <br /> > Does parcel meet Zoning Requirements? Yes No De5-0)-- am <br /> V <br /> a ➢ Does parcel require a Survey? Yes No <br /> caro• 'O�o o <br /> Permit application fees submitted? 0 Amount$ Receipt# <br /> r ®Reconciles with Real Property Lister arill No Date: 17422 42.1 VI <br /> DI <br /> a' If not,explain: <br /> r <br /> , <br /> Pe <br /> Application: , 'proved / D nied Reason for Denial: <br /> LIS/vty I e 11 si a t/r�ol ac cK7' /I7/oq►�r,�ilf i n Yob's yo <br /> Land Use: ' J //z8/e. Z/ Date: <br />