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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> and/or Pre-Application Form or Map Review Form Subdivision w/o Survey: $50.00 <br /> Survey of Existing Parcel: $50.00/lot <br /> Subdivision w Survey: $200.00+$50.00/lot <br /> Ohsner: Virginia King Buyer: <br /> Address: 27925 LONE PINE RD Address: <br /> WEBSTER WI 54893 z <br /> ivi <br /> Phone: Phone: t,.. <br /> 1 <br /> Original Parcel Information %I <br /> Parcel ID#:07-020-2-40-16-29-5 05-002-012120 Section 29 Township 40 Range 16 9 <br /> c <br /> Original Description (or attach copy): Lot 7, Burnett County Certified Survey Map No. 4877 <br /> Volume 27, pages 163-165, in Gov. Lots 1 & 2 < <br /> ' <br /> Current Zoning: RR-1 Floodplain Y/N: Y Wetlands Y/N: N Lake/River Class: <br /> N/A ' : <br /> .a Name of Water Body: Yellow Lake Shoreland Agreement/SIPS Y/N: N <br /> ms <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N: N '.. <br /> o �C <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: We are submitting a new CSM that <br /> creates four new lots. <br /> Acres: 7.66 A <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: Direct access to Lone Pine Road and easements as shown v <br /> n <br /> Proposed access to public waters to be provided Y/N: N W <br /> 4i <br /> 1 <br /> If yes,describe access: ,'\ <br /> Signature of Owner: Z sC'� 7? Date: 3.... f3 _ za <br /> ' , n <br /> Jmnature of owner: j�r I G y�`I - uate: 3 <br /> 7 <br /> ➢ Does parcel meet Zoning Requirements? Yes No eo <br /> N ➢ Does parcel require a Survey? Yes No Q W <br /> O <br /> q' ➢ Permit application fees submitted? 0 Amount$ �D/ Receipt# <br /> 0 Reconciles with Real Property Lister Yes No Date: <br /> If not,explain: <br /> a <br /> e <br /> n <br /> o ... -- _ <br /> y, Application Approved / enied Reason for Denial: <br /> Land Use: ( -yZy2 z3 Date: <br />