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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 or Map Review Form Subdivision w/Survey:$200.00+$50.00/lot <br /> 1.4 SI <br /> ro <br /> Owner: Erickson _ CO ,rtie-raa-is LLC Buyer: ea i d ••• <br /> PO Box 614 n <br /> Address: Address: <br /> Webster WI 54893 <br /> Phone: Phone: J V <br /> ILIN <br /> Original Parcel Information fb <br /> Tax m#: 07-018-2-39-16-28-2 03-000-011000 Section 28 Township 9N tbinge 16W <br /> Original Description(or attach copy):SW-NW ex GSM V14 P179 <br /> i <br /> Current Zoning: C-1 Floodpiain Y/N:N Wetlands YIN:N Lake/River Class: <br /> Name of Water Body:N/A Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation Y/N:N Managed Forestry Law YIN: N <br /> r <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: C$M <br /> r <br /> rr: <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 /> C7 <br /> Proposed access to public waters to be provided YIN: 7P <br /> If yes,describe access: <br /> Signature of Owner. �` _...,--__ Date: ,,7 11'2 3 0 <br /> Signature of Owner: Date- <br /> ➢ Does parcel meet Zoning Requirements? Yes No ei Check <br /> Rec:Date- <br /> , <br /> check#:11117 <br /> ➢ Does parcel require a Survey? Yes No 1 0 8V- <br /> i <br /> Reconciles with Real Property Lister 411100 No Date: OI /rW 5 <br /> If not,explain: <br /> Application• pp o ed / D nied Reason for Denial. k <br /> Land Use: , Date: t <br /> 87zs7Zo z3 c <br /> i <br /> 4110►i/1$ , / ,/„4Q/ h e//4i CX,s)4//40/4 74 <br /> /✓f 6itl o v^_ a b1 4s c 4 e4V1e.!''9( ZOH/it G 04 <br /> ..57/7Ao0 7, <br /> access b1e- W/>1 /5 ,0 17 <br />