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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> and/or Pre-Application Form or Maid Review Form Subdivision w o Survey: $501K) <br /> hP P Survey of Existing Parcel: $50.00/lot <br /> Subdivision�r'Survev: S200.00+$50.00/lot <br /> O-vv ner: Buyer: <br /> Mark Bell Martina Maslow - Life Estate b <br /> A <br /> Represented by Alan Maslow <br /> Address: 2137 80th St. Address: =� <br /> z <br /> Somerset, WI 54025 6780 County Road B kpl <br /> 651-341-8239 Siren, WI 54872 <br /> Phone: Phone: <br /> Original Parcel Information <br /> Parcel ID#: Tax ID 20455 & 20454 Section 22 Township 38 Range 16 <br /> Original Description(or attach copy): SE'/4-NE'/a and SW'/4-NE'/a, Section 22, T38N-R16W <br /> Current Zoning: A-2 Floodplain Y/N: N Wetlands Y/N: N Lake/River Class: N/A <br /> .a Name of Water Body: Shoreland Agreement/SIPS Y/N: N <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N: N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: A two outlot CSM will be done to <br /> create parcels to be swapped between Ball and Maslow. <br /> c7 <br /> Acres: 1.52 and 0.51 Acres <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Direct access to Lynch Bridge Road d <br /> Proposed access to public road: y g <br /> Proposed access to public waters to be provided Y/N: N y� <br /> If yes,describe access: <br /> Signature of Owner: X4_.07' Date: <br /> ra <br /> -)ignature of owner: vate: <br /> 0 <br /> r Does parcel meet Zoning Requirements? Yes No =i <br /> N ➢ Does parcel require a Survev? Yes No <br /> o � <br /> 0 <br /> Y Permit application fees submitted? ❑ Amount$ Receipt# <br /> ❑ Reconciles with Real Property Lister Yes No Date: -�- <br /> If not,explain: <br /> 0 <br /> a Applicatio �. A�pproved enied Reason for Denial: <br /> Land Use: Date: <br /> / 3o ZOZ <br />