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OM <br />Burnett County Subdivision Permit Application Fees (must accompany form): <br />and/or Pre -Application Form or Ma Review Form Subdivision w/o Survey: $50.00 <br />hh p Survey of Existing Parcel: $50.00/lot <br />Owner: <br />Address: <br />Robert Brewster <br />23968 1 st Ave. <br />Siren, WI 54872 <br />Phone: 715-349-5317 <br />Subdivision w/ Survev: 8200.00 + S50.00/lot <br />Buyer: Wallace Benson <br />Address: 6598 Pike Bend Road <br />Webster, WI 54893 <br />Phone: 715-866-8618 <br />Original Parcel Information <br />Parcel ID #: 018 3327 01400 Section 27 Township 36 Range 16 <br />Original Description (or attach copy): Parcel described in Document No. 349393, <br />SE'/4-NE'/4, Section 27, T39N-R16W. <br />Current Zoning: A-2 Floodplain Y/N: Wetlands Y/N: N Lake/River Class: <br />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 o�w V. (�* C 1 —100 <br />Proposed New Legal Description and Parcel Size: This survey will create a new parcel. <br />This parcel contains the driveway to Mr. Benson's house. No easement <br />of record exists. It is not intended to be used for building. <br />Aces: 7.5 cres f <br />(If parcel is to be surveyed, provide preliminary Jap. See attached for preliminarrmap requirements. <br />Proposed access to public road: Direct Access to Pike Bend Road. <br />Proposed access to public waters to be provided Y/N: N <br />If yes, describe access: <br />Signature of Owner: <br />Ntgnature of owner: <br />➢ Does parcel meet Zoning Requirements? <br />➢ Does parcel require a Survey? <br />i Permit application fees submitted? <br />❑ Reconciles with Real Property Lister <br />If not, explain: <br />Date: <br />Late: <br />No <br />r <br />((LesNo <br />Amount $ 42jrZv OD Receipt # <br />Yes No Date: <br />Applicatio • Appro d% Denied Reason for Denial: 1111 MAR — 2 2017 1 U j <br />Land Use: 09/17 <br />Date: <br />BURNETT COUNTY <br />ZONINn <br />w <br />�J <br />