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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 w/Survey: $200.00+$50.00/lot <br /> b <br /> H eD <br /> Owner: Ira Kyle Werdier Buyer: c 3 <br /> C <br /> PO Box 144 °' <br /> Address: Address: et p <br /> Webster WI 54893 c <br /> to <br /> N <br /> Phone: Phone: `.' <br /> Original Parcel Information <br /> Tax ID#: 07-032-2-41-16-28-5 15-016-029000 Section 28 Township 41 N Range 16W <br /> 07-032-2-41-16-28-5 15-016-030000 <br /> Original Description(or attach copy): <br /> Lots 5&6 Block 9 AM Brooks 1st Addition <br /> 19 <br /> -e <br /> Current Zoning: RR1 Floodplain Y/N: N Wetlands Y/N: 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 Y/N: N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: C S M <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) y <br /> X <br /> Proposed access to public road: C <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: <br /> Signature of Owner: Alh kI"". Date: !� / /�U <br /> Signature of Owner: Date: <br /> Fee Rec: <br /> Does parcel meet Zoning Requirements? Yes No Check#: <br /> > Does parcel require a Survey? Yes No m <br /> c-` <br /> z; <br /> G <br /> X <br /> Reconciles with Real Property Lister Yes No Date: F <br /> m <br /> c, <br /> If not,explain: 71 <br /> m <br /> m <br /> 0 <br /> z <br /> r <br /> Application: Approved / Denied Reason for Denial: m <br /> m <br /> Land Use: Date: c <br /> m <br />