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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+$50.00/lot <br /> 0.4 b <br /> Owner: Cabaret Owners Group LLC � ; - - _ g 3 <br /> C :: <br /> Address:3230 Vaughn Park Dr Address: - A <br /> Webb Lake WI 54830 { - w <br /> Phone: Phone: <br /> Original Parcel Information d IsZ <br /> Tax ID#: 07-038-2-41-14-28-2 03-000-020000 Section 28 Township 41 N Range 14W <br /> OriginalDescnpuonkorauucu.,..py1. W341 .8 ' of N1 /2 SW—NW <br /> tv <br /> eI <br /> Current Zoning: Cl Floodplain Y/N:N Wetlands Y/N: N Lake/River Class: <br /> 1 <br /> Name of Water Body: NIA Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation YIN:N Managed Forestry Law Y/N: N <br /> I% <br /> New Parcel Information * <br /> Proposed New Legal Description and Parcel Size: CSM t <br /> Acres <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) r y <br /> Proposed access to public road: <br /> C <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: Zr <br /> r <br /> Signature of Owner. Date: (o/1 b/7-0 7-3 <br /> Signature of Own Date: 4'( i"(1-? <br /> m <br /> .., Fee Rec:Z$Z' <br /> > Does parcel meet Zoning Requirements? Yes No at <br /> Check#:cic ‘09/3 <br /> 0 <br /> > Does parcel require a Survey? Yes No g <br /> ci <br /> v <br /> m <br /> Reconciles with Real Property Lister Yes No Date: n <br /> v, �J <br /> If not,explain: <br /> a r <br /> z m oD 1..... <br /> NO <br /> �l V <br /> Applicati i Approved I !enied Reason for Denial. 1m <br /> Ly: Date: o oel ti <br /> �-v l7 �� c <br /> N <br /> 1fl <br /> Quf-o cyer74.1 �v1/' 0 /)ar - L____)J <br />