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Burnett County Subdivision Permit Application <br />Fees (must accompany form): <br />and/or Pre -A lication Form or Ma Review Form <br />pp p <br />Subdivision w/o Survey: $50.00 <br />Survey of Existing Parcel: $50.00/lot <br />Amount $ <br />Subdivision w/ Survev: $200.00 + $50.00/lot <br />Owner: <br />Kelly Brown <br />Buyer: <br />Address: 28281 Johnson Lake Road Address: <br />Webster, WI 54893 <br />612-245-2961 <br />Phone: Phone: <br />Original Parcel Information <br />07-020-2-40-16-36-1 03-000-012100 <br />Parcel ID #: 07-020-2-40-16-36-1 03-000-012001 Section 36 Township 40 Range 16 <br />07-020-2-40-16-36-4 02 --0-011000 012100 = E'/2 SW'/4NE is Ex S660', currently owned by <br />Original Description (or attach copy): <br />Brown: 012001 = S660' SW'.-':' E%4 Ex W465', currently owned by Graveson, to be purchased by Bror <br />011000 = S660' SW'/NEY4 Ex W465', currently owned by Graveson, to be purchased by Brown; <br />Current Zoning: A-2 Floodplain Y/N:___L_Wetlands Y/N: N Lake/River Class: <br />Name of Water Body: <br />Farmland Preservation Y/N: <br />Shoreland Agreement/SIPS Y/N: <br />Managed Forestry Law Y/N: N <br />New Parcel Information <br />Proposed New Legal Description and Parcel Size: ,'Jr. Brown is purchasing the Diane Graveson property <br />At that point, will own 3 contiguous parcels tot. -)proximately 53 acres. He would like to <br />create two minimum sized lots around the ` '-SM Acres: —1.3 A + — 1.7 A <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 Graveson Road <br />Proposed access to public waters to be provided Y/N: N <br />If yes, describe access: <br />Signature of Owner: Date: <br />signature of L)wner: Late: <br />➢ Does parcel meet Zoning Requirements? Yes No <br />➢ Does parcel require a Survey? <br />Yes <br />No <br />i Permit application fees submitted? ❑ <br />Amount $ <br />a� <br />'3040 Receipt # <br />❑ Reconciles with Real Property Lister Yes No Date: <br />If not, explain: <br />Applicatio : Approved / Denied Reason for Denial: <br />Land Use: ► S !S 4.51;1 <I iJP�1 S/ /V / /O <br />0 <br />S <br />