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a <br />Ij <br />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: Daniel Sutton Buyer: Donald Sutton <br />Address: PO Box 66 Address: PO Box 82, 27354 Stone Rd 3 <br />z <br />Webster, Wl 54893 Webster, WI 54893 ° <br />Phone: ESI' tC''1� `> ��.2 Phone: 71's - <br />Q <br />Original Parcel Information <br />07-020-2-40-16-35-3 01-000-011200 Q <br />Parcel ID #: 07-020-2-40-16-35-3 01-000-011300 Section 35 Township 40N Range 16W <br />Original Description (or attach copy): Lots 1 & 2 CSM #4336, V23 P222 (NE SW) <br />Current Zoning: A2 Floodplain Y/N:__U_Wetlands Y/N: Y Lake/River Class: - <br />Name of Water Body: - Shoreland Agreement/SIPS Y/N: - <br />Farmland Preservation Y/N: - Managed Forestry Law Y/N: - <br />New Parcel Information <br />Proposed New Legal Description and Parcel Size: Redivision of existing 2 lot CSM: V23 P222 <br />Acres: 25.34 <br />(If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Proposed access to public road: existing <br />Proposed access to public waters to be provided Y/N: N <br />If yes, describe access: <br />L Signature of Owner: <br />/Signature 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 />Yes <br />Yes <br />Amount $ <br />Date: <br />Date: <br />IN10 Ap-c- 1011"a - <br />No cle, Ad- rte' 73 7 <br />Od <br />la , Receipt # <br />Yes No Date: <br />Denied Reason for Denial: <br />Land Use: l% ( I- // ?/ ?—Of � Date: <br />V <br />