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Burnett County Subdivision Permit Application <br />Fees (must accompany form): <br />and/or Pre -Application Form or Review F <br />pp Map p ew orm <br />Subdivision w/o Survey: $50.00 <br />Survey of Existing Parcel: $50.00/lot <br />Subdivision w/ Survev: %,200.00 +,%,50.00/lot <br />Owner: Basler Trust Buyer: Larry Ray <br />Address: 3437 CHENOWETH DR Address: 27755 THOMPSON RD <br />WEBSTER WI 54893 WEBSTER WI 54893 <br />Phone: <br />715-833-7798 <br />Phone: 715-733-0039 <br />Original Parcel Information <br />Parcel ID #: 012422504800 Section 25 Township 40 Range 15 <br />Original Description (or attach copy). Lot 3, Burnett County Certified Survey Map No. 1726 <br />located in Gov. Lot 4. <br />Note this is an exchange of land between adjoining owners where the lots are <br />not reduced e ow a minimum. <br />Current Zoning: RR -1 Floodplain Y/N:---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 <br />Proposed New Legal Description and Parcel Size: A small portion (6349 sq. ft.) of Lot 3 will <br />be deeded to the owner of Lot 4 by metes & bounds description prepared by <br />Douglas R. Crane. See Attached. <br />Acres: 6349 sq.ft. <br />(If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Proposed access to public road: N/A <br />Proposed access to public waters to be provided Y/N: N <br />If yes, describe access: <br />Signature of Owner: <br />signature of vwner: <br />N/A <br />➢ Does parcel meet Zoning Requirements? <br />➢ Does parcel require a Survey? <br />�01 Permit application fies submitted? <br />Date: <br />nate: <br />Yes No <br />Yes No <br />Amount $_ @ I / (l TTIN Receipt # <br />❑ Reconciles with Real Property Lister Yes No Date: <br />If not, explain: <br />Application: Approved / <br />Land Use: <br />Reason for Denial: <br />9/Zo // 7 <br />GSI✓t, -"I I y e v'17V 4hy'/ exii'7' 4r z&m; <br />l tS !1 e. �y cA I. -A 1% t'h e. -ffi e— nekJ Po Nu <br />Date: <br />ur osef u�1�%4a ,oGS`''l <br />W <br />