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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+$50.00/lot <br /> Owner: Scott Rykal Buyer: ^: <br /> eD <br /> Address:27500 Reitz Rd g. <br /> Address: <br /> Webster WI 54893 <br /> 0 <br /> Phone: Phone: <br /> N <br /> Original Parcel Information <br /> 07-020-2-40-16-33-515-015-016000 33 40N <br /> Parcel ID#: Section Township Range 16W <br /> ct-1 <br /> Original Description(or attach copy): Albert Kulbeck's Sub of Devils Lake Lot 6 & 7 Blk 1 �� <br /> (. <br /> Current Zoning: RR1 Floodplain Y/N: Y Wetlands Y/N: N Lake/River Class: <br /> Name of Water Body: Devils Lake Shoreland Agreement/SIPS Y/N: /� <br /> a <br /> Farmland Preservation YIN: N Managed Forestry Law YIN: N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: CSM to combine 2 existing lots <br /> Acres:0.48 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: p <br /> m <br /> n <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: ;,-. . <br /> Signature of Owner: 3-'G6� Date: <br /> / l N <br /> Signature of Owner: Date: �o <br /> 3 <br /> c <br /> > Does parcel meet Zoning Requirements? Yes No C -e o 7 Z.Z n <br /> z <br /> > Does parcel require a Survey? Yes No <br /> Permit application fees submitted? ❑ Amount$ -CO ' Receipt# <br /> t- ® Reconciles with Real Property Lister No Date: 1'L-�q-22_ <br /> = <br /> c If not,explain: <br /> n <br /> 0 <br /> Application: roTO Denied Reason for Denial: <br /> ee_ P !ANA"t'71— #- Z OP—/7 — V3Z- <br /> Land Use: /�/20OZ 2—Date: <br />