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Fee (must accompany form): <br />Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br />Survey of Existing Parcel: S50,00i'lot <br />and/or Pre -Application Form Subdivision w/ Survev: $200.00 + $50,00/lot <br />I <br />Owner: JUlie Heinz Buyer: ti <br />ro <br />Address: 2Z689 State Rd 35 Address: <br />Webster, Wl 54893 <br />Phone: 715-416-1716 Phone: <br />Oridnal Parcel Information <br />Parcel I-D #: 07-020-2-40-16-29-4 04-000-011000 Section 29 Township 40N Range 16W <br />O <br />Original Description (or attach copy). N1/2 SE SE & also PCI Desc 618/528 Ex RR RW & Ex HWY <br />Desc #379115 <br />> Current Zoning: A2 Floodplain V/N:—N!—Wetlands Y/N: N Lak-e/River Class: 0a <br />;q* Name of Water Body- N/A <br />Shoreland Agreement/SIPS y/N. N/A <br />Farmland Preservation Y/N. N Managed Forestry Law Y/N: N <br />New Parcel Information <br />Proposed New Legal Description and Parcel Size: <br />Acres: <br />(If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Proposed access to public road: <br />Proposed access to public waters to be provided WIN: <br />If yes, describe access: <br />Signature of <br />Signature of Owner: <br />" 1-n <br />Date: <br />Date: <br />)i- Does parcel meet Zoning Requirements? Yes No <br />Does parcel require a Survey? Yes No <br />IV <br />Permit application fees submitted? 0 knount $ Receipt 4 <br />0 Reconciles with Real Property Lister Yes No <br />If not, explain: <br />Application: Approved / Denied I <br />US 140� eM (,.,'7'V 6 IV-a-1 <br />Land <br />for <br />-A)., Move gAw" <br />Date: '7t- 4- 2— <br />all <br />