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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 or Map Review Form Subdivision v/Survey: $200.00+$50.00/lot <br /> Buyer applying/signing on current owner's ed fp <br /> Owner:behalf. See attached authorization Ietter.Buyer: Webster DG, LLC A @ <br /> m <br /> Address: Address.361 Summit Blvd.,Suite 110 A o <br /> Birmingham,AL 35243 �N <br /> Phone: Phone: 205-968-9220 N <br /> Original Parcel Information <br /> Tax ID#: 07-028-2-404446-3 04-000-015000 Section 16 Township 40 N Range 14 W <br /> Original Description(or attach copy): See attached ALTA <br /> b <br /> ry <br /> W Prop Line-unclear if on our property p <br /> Current Zoning: C4 Floodplain Y/N: N Wetlands Y Lake/River Class. <br /> Low Namekagon Riv Watershed N <br /> crName of Water Body: N/A Shoreland Agreement/SIPS YIN: <br /> Farmland Preservation YIN: N Managed Forestry Law Y/N: N .� <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: See attached ALTA <br /> Acres. 2.5 IV <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: County Road A <br /> Proposed access to public waters to be provided Y/N: N E <br /> If yes,describe acce • Ai_ <br /> lb 'Signature of Owner tg ��A Date: oq�/ <br /> Signature of Owner: Date: <br /> Fee Rec: 35V,DO <br /> > Does parcel meet Zoning Requirements? Yes No Check#: q Z <br /> Y Does parcel require a Survey? Yes No a <br /> 0 <br /> CD <br /> Reconciles with Real Property Lister Yes No Date: GO <br /> If not,explain: i' i 1 <br /> X07 <br /> : 1 .._ ?V <br /> Application: proved / enied Reason for Denial: '/ iN 6 <br /> Land U •• — Date: 7 �'/ Z ZThill <br />