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/ <br /> Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision who Survey: $50.00 <br /> Survey of Existing Parcel: $50.00/lot <br /> and/or Pre-Application Form Subdivision w/Survey: $200.00+$50.00/lot <br /> Owner: Jody Lundell Buyer: Dennis Main <br /> iv <br /> Address:3664 Mount Vernon LnAdm: 2917 Des Moines Trl i <br /> Woodbury WI 55129 Webb Lake WI 54830 0 <br /> c <br /> Phone: Phone: C.3'.i <br /> Original Parcel Information U <br /> 07-038-2-41-14-28-5 05-001-011000.05.002-017000.15-847-011000 <br /> Parcel ID#: Section 28 Township 41 Range 14 <br /> Original Description(or attach copy): Lot 2 CSM V4 P174, Lot 1 CSM V17 P66, g <br /> eo <br /> Whispering pines Lot 1 BIk 1 11 <br /> t" <br /> . Current Zoning: RR1 Floodplain Y/N: Y Wetlands Y/N: N Lake/River Class: <br /> ... <br /> c Des Moines Lake <br /> Name of Water Body: Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation Y/N:N Managed Forestry Law Y/N:N <br /> New Parcel Information <br /> d <br /> Proposed New Legal Description and Parcel Size: CSM <br /> U <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) (')r... <br /> Proposed access to public road: C <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: <br /> Signature of Owner: . �¢Q Date: 1 -0©r Lc 2-1 N <br /> Z\Iti, <br /> Signature of(it : avA <br /> /M44, Date: 9- '-,,,W I °8 <br /> ➢ Does parcel meet Zoning Requirements.? es No cbg-69qVD <br /> A <br /> I" ➢ Does parcel require a Survey? Yes No o Aa /O/,s/?.d Z/ <br /> n � N <br /> 00 D Permit application fees submitted? 0 Amount$ LC;0 <br /> — Receipt# 6j <br /> Z. <br /> ®Reconciles with Real PropertyLister `J <br /> � �.i� No Date: 10�7�ZI K> <br /> a. If not,explain: <br /> k.gfif <br /> a <br /> 40 <br /> lv <br /> J <br /> Applicati Approved / De ed Reason for Denial: <br /> Land Use: 7.40Z Z Date: <br />