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Fees(must accompany foma): <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+$50.00/1ot <br /> owner: Wendell Viebrock Buyer: ,y <br /> Address: -620 240th St- - - - Address: - - - - - -- <br /> - — a <br /> Osceola. WI 54020 z <br /> 0 <br /> 6A <br /> c <br /> Phone: (715)417-0886 Phone: lP <br /> Original Parcel Information L <br /> Parcel ID#. 07-036-2-40-17-36-5 15-577-043000 Section 36 Township4 ON Range 17W W <br /> O <br /> Original Description(or attach copy): The Pines Lots 9, 10, 11 Blk 3 <br /> C� <br /> G <br /> Current Zoning: RR1 Floodplain Y/N: N Wetlands Y/N: N Lake/River Class: N/A <br /> Name of Water Body: N/A Shoreland Agreement/SIPS Y/N: N <br /> Farmland Preservation YrN: N Managed Forestry Law Y/N: N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: <br /> 2 Lot CSM combining Lots 10 & 11 and remapping Lot 9 <br /> Acres: 0.51 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: Existing C7 <br /> Proposed access to public waters to be provided Y/N: N <br /> If yes,describe access: <br /> ..,_ <br /> Signature of Owner: Date: <br /> Signature of Owner: Date: c <br /> 8 <br /> ti <br /> c <br /> > Does parcel meet Zoning Requirements? Yes evo <br /> c <br /> > Does parcel require a Survey? Yes 1Vo <br /> a' <br /> Permit application fees submitted? ❑ Amount$ Receipt# <br /> r ❑Reconciles with Real Property Lister Yes No Date: <br /> n <br /> c <br /> If not,explain: <br /> m <br /> n <br /> o <br /> C <br /> Applicatio . pproved / nied Reason for Denial: I III <br /> Land Use: Date: I a D <br /> Bumett County <br /> Land Services Department <br />