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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: S50.00 <br /> Survey of Existing Parcel: S50.00/lot <br /> Subdivision w Survey: S200.00+S50.00/lot <br /> Owner:Wayne Larabee Buyer: <br /> et <br /> Address: 6350 Haaf RD Address: g. <br /> WEBSTER WI 54893 z <br /> Phone: Phone: <br /> Original Parcel Information IJ <br /> & 020432601200 V` <br /> Parcel ID#:020432601300 Section 26 Township 40 Range 16 <br /> Original Description(or attach copy): Part of the NW'/a-NEB/a 5 <br /> Current Zoning: a Floodplain Y/N: N Wetlands Y/N: Y Lake/River Class: <br /> N/A ft.. <br /> -a Name of Water Body: Unnamed Pond/Wetland Shoreland Agreement/SIPS Y/N: N <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N: N <br /> New Parcel Information q <br /> Proposed New Legal Description and Parcel Size: We are submitting a new CSM that n <br /> creates 1 new lot. The existing 10 acres parcel will be eliminated. A CUP will be <br /> approved to create this lot in A zoning <br /> Acres: 10 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 Bushey Road. m <br /> A <br /> Proposed access to public waters to be provided Y/N: N <br /> If yes,describe access: <br /> Vq <br /> % <br /> (- �/ <br /> Signature of Owner: 4,,, , ,,,, ,__Q Date: ' 1 - A 3 <br /> . <br /> signature of owner: uate• c <br /> c <br /> Does parcel meet Zoning Requirements? Yes No 00/ - <br /> N ➢ Does parcel require a Survey? Yes No GI <br /> °o O '�' <br /> Permit application fees submitted? ❑ Amount$ �..5 ' Receipt# <br /> cra <br /> N1 <br /> 0 Reconciles with Real Property Lister Yes No Date: N <br /> aIf not,explain: ' -- <br /> a <br /> CX1 <br /> c. Application: Approved Denied Reason for Denial: F <br /> �� VILand Use: 41 Date: 9'g/ZO Z3 <br /> Rewla,N. e r o14 x ,/' /3G 8/ / cam/. 4fe/I),) 7(X i¢"/3c8'0 <br />