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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br /> and/or Pre-A lication Form Survey of Existing Parcel: $50.00/lot <br /> PP Subdivision w/Survey: $200.00+$50.00/lot <br /> Owner: Mike Bentley Buyer: <br /> t <br /> to <br /> Address:6880 Stengel Dr <br /> Address: <br /> Webster WI 54893 <br /> cA <br /> Phone: Phone: <br /> Original Parcel Information <br /> Parcel ID#: 07-018-2-39-16-15-3 01-000-011000 Section 15 Township 39N Range 16W <br /> Original Description(or attach copy): NE-SW <br /> A <br /> 3 <br /> fo ' <br /> Current Zoning: A2 Floodplain Y/N: N Wetlands Y/N: Y Lake/River Class: <br /> Name of Water Body: Shoreland Agreement/SIPS Y/N: E('SY) <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N:N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: CSM <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> eD <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: c <br /> Signature of Owner: /� !/2a2Z Date: <br /> Signature of Owner: Date: a' <br /> a <br /> > Does parcel meet Zoning Requirements? Yes No e'7 7, <br /> N / <br /> > Does parcel require a Survey? Yes No <br /> o /�7 �0 1 <br /> 00 Permit application fees submitted? 0 Amount$ /vr , Receipt# <br /> -l` <br /> 0 Reconciles with Real Property Lister Yes No Date: 01(03, <br /> o N <br /> °' If not,explain: <br /> A <br /> Applicatio�pproved 1� d Reason for Denial: <br /> Land Use: Date: 7 // 2i9 <br />