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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 Subdivision w/Survev: $200.00+$50.00/lot <br /> Owner: Judith A. Foote Buyer: St. Croix Materials LLC b <br /> A <br /> Address: P.O.Box 504 Address: 9776o Hi ghwa3c-35 S <br /> x <br /> z <br /> Webster, WI 54893 Webster, WI 54893 <br /> Phone: 715-866-7574 Phone: 715-866-4157 (� <br /> 1 ,;. Orieinal Parcel Information `1 , <br /> ' 107-020-2-40-16-28-3 01-000-01100 ection 28 Township 40N Range 16W <br /> Parcel ID#: <br /> Oriinal Description(or attach copy): The Northeast Quarter of the Southwest Quarter (NEa SWa) <br /> of ection Twenty-eight (28), Township Forty (40) North, Range Sixteen (16) West, Burnett <br /> County, Wisconsin, excepting therefrom the West Half of the West Half N Wj) of said <br /> NMVIWT Lmarter ot the Swthwest Quarter , 28-40N-16W, Burnett County, WI. <br /> V <br /> Current Zoning: A-2 Floodplain Y/N: No Wetlands Y/N:No Lake/River Class: n/a <br /> t <br /> m Name of Water Body: n/a Shoreland Agreement/SIPS Y/N: No <br /> e <br /> Farmland Preservation Y/N: No Managed Forestry Law Y/N: No <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: See attached rider <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: Buyer owns adjacent land with access to County Road C o <br /> y <br /> Proposed access to public waters to be provided Y/N: No <br /> If yes,describe access: ,��'' LL��7 <br /> Signature of Owner: G� Q - Date:3-0—/5 <br /> Judith A. Foote <br /> Signature of Owner: Date: 3 <br /> v <br /> e <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> u <br /> o ➢ Does parcel require a Survey? Yes No d <br /> o � <br /> °0 ➢ Permit application fees submitted? Amount S _hn,00 Receipt# 80 <br /> rd Reconciles with Real Property Lister be No Date: <br /> m <br /> e <br /> ° If not,explain: _ <br /> o <br /> a <br /> W <br /> Applicati Approved / enied Reason for Denial: a <br /> Land Use: Date: <br />