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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 h Survey of Existing Parcel: $50.00/lot <br />Robert Brewster <br />Owner: <br />Address: <br />Phone: <br />23968.1 st Ave. <br />Buyer: <br />Address: <br />Siren, WI 54872 <br />715-349-5317 <br />Phone: <br />Subdivision w/ Survev: 8200.00 + S50.00/lot <br />Wallace Benson <br />6598 Pike Bend Road <br />z <br />Webster, WI 54893 <br />715-866-8618 <br />Original Parcel Information <br />Parcel ID #: <br />018 3327 01400 Section 27 Township 36 Range 13 <br />Original Description (or attach copy): Parcel described in Document No. 349393, <br />SEY4-NEY4, Section 27, T39N-R16W. <br />Current Zoning: Floodplain Y/N:___Y 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: ``4 <br />New Parcel Information <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. 7.5 Acres <br />(If parcel is to be surveyed, provide preliminary map. See attached for preliminary map 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 />d <br />m <br />Signature of Owner: Date: <br />n <br />wgnature of towner: nate: <br />c <br />➢ Does parcel meet Zoning Requirements? Yes No <br />xt <br />➢ Does parcel require a Survey? Yes No <br />Permit application fees submitted? ❑ Amount $ Receipt # <br />❑ Reconciles with Real Property Lister Yes No Date: <br />If not, explain: <br />l <br />Application• Approved / nied Reason for Denial: <br />Land Use: <br />rV�uS c 1 � s awe/ <br />V CSm N 7 D �� I lei <br />Date: <br />ZONING <br />