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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: Erickson Family Investments, LLC Buyer: <br /> co <br /> Address: PO Box 614 Address: i. <br /> Webster. WI 54893 P <br /> Phone: Phone: <br /> Original Parcel Information <br /> 07-018-2-39-16-28-3 02-000-012300 28 Township39N Range 16W W <br /> Parcel ID#: 07-018-2-39-16-28-3 02-000-012400 Section g <br /> 07-018-2-39-16-28-3 02-000-012200 $ <br /> Original Description(or attach copy): co <br /> eD <br /> Lots 2, 3, &4 of CSM V23 P234 (NW SW) <br /> 1, <br /> .d Current Zoning: Cl Floodplain Y/N: N Wetlands Y/N: N Lake/River Class: N/A <br /> b <br /> f N/A Shoreland Agreement/SIPS Y/N: N <br /> m Name of Water Body: g <br /> a <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N: N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: New 1 Lot CSM combining 3 existing parcels <br /> Acres: 5.48 r <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road:Existing d <br /> ,.. <br /> co <br /> Proposed access to public waters to be provided Y/N:N b\ <br /> � <br /> If yes,describe access: N/A <br /> '\_ <br /> ( z A �l <br /> Signature of Owner: <br /> -- ,� Date: I2'/ J - 1 I lJ <br /> PZ <br /> Signature of Owner: Date: <br /> 2TS <br /> C <br /> D Does parcel meet Zoning Requirements? Yes No s <br /> o )• Does parcel require a Survey? Yes No Gei/V W <br /> Q0 D' Permit application fees submitted? ❑ Amount$ Receipt# <br /> N is <br /> o0 <br /> ❑ Reconciles with Real Property Lister Yes No Date: e W <br /> o <br /> F If not,explain: NO <br /> n <br /> 0 jV <br /> o. <br /> _ a1 sF1V m <br /> Applicaf . proved / Hied Reason for Denial: <br /> Land Use: 00°0f Date: <br /> & rCounty <br /> Land Services acpartinent <br />