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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+$50.00/lot <br /> ., b <br /> to <br /> Owner: Dean Perry Buyer: e 2 <br /> C �* <br /> Address:28124 County Rd H Address: 0 p <br /> Webster WI 54893 <br /> Phone: Phone: riz) `^ <br /> Original Parcel Information p, <br /> Tax ID#: 18378 & 18377 Section 21 Township 40 Range 14 '` <br /> O <br /> Original Description(or attach copy): NE-SE & NW-SE ex County Road & West of CTH H <br /> kj1 CD16 <br /> Current Zoning: RR3 Floodplain Y/N:N Wetlands Y/N: N Lake/River Class <br /> Name of Water Body: Shoreland Agreement/SIPS Y/N: d <br /> Yw_s <br /> Farmland Preservation YIN: N Managed Forestry Law Y/N: N „ ,tNew Parcel Information <br /> Via; <br /> Proposed New Legal Description and Parcel Size: CSM <br /> Acresig <br /> - <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: C <br /> xt <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: <br /> S a i_ ...O ate: <br /> > Does parcel meet Zoning Requirements? Yes No Fee Rec: 2.5-4 11-42 <br /> Check#: fo 2/ SS <br /> > Does parcel require a Survey? Yes No <br /> Reconciles with Real Property Lister Yes No Date: <br /> If not,explain: <br /> Applicatiq 'Approved enied Reason for Denial- <br /> Land .": Date: <br /> /. /zoa$ <br />