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Fees(must accompany form): <br /> Burnett County Subdivis on Permit Application Subdivision w/o Survey: $50.00 <br /> Survey of Existing Parcel: $50.00/lot <br /> and/or Pre-Application F rm or Map Review Form Subdivision w/Survey: $200.00+$50.00/lot <br /> ma <br /> owner: Patrick & Stacey Taylor Buyer: 1 1 <br /> d <br /> sa <br /> Address:PO Box 365 Address: A <br /> Webster WI 54893 <br /> Phone: Phone: `t' <br /> Original Parcel Information <br /> 07-018-2-39-16-03-5 0 01-011000 03/34 39/40 16 <br /> Tax ID#: - - - - - Section .Township Range <br /> 07-018-2-39-16-03-10 00-011000 <br /> Original Description(or attach copy): GL1 &GL 2 & SW-NE <br /> i <br /> 0 <br /> A <br /> Current Zoning: RR2/A2Floodplain YIN:Y Wetlands Y/N: N Lake/River Class. P <br /> i <br /> J <br /> Name of Water Body:Devils Lake Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation YIN: N Managed Forestry Law Y/N: N <br /> New Parcel Information ik <br /> Proposed New Legal Description and Parcel Size: CSM to change existing lot lines R <br /> -A,---- <br /> Acres* <br /> fi <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) 1' <br /> Proposed access to public road: <br /> 8 <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: C C <br /> Signature of Owner: r Date:4 Z/ y <br /> Signature of Owner: Date: <br /> o0 <br /> Fee Rec: a <br /> ➢ Does parcel meet Zoning Requirements? Yes No Check#: lvO QD 7 <br /> > Does parcel require a Survey? Yes No P <br /> 8 <br /> [y <br /> C <br /> Reconciles with Real Property Lister Yes No Date: Pi <br /> N <br /> If not,explain: a <br /> 0 <br /> •e <br /> Applicatio i• Approv•I Denied Reason for Denial: <br /> Land U • C(� Date: <br /> / zo z3 <br /> i <br />