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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+$50.00/lot <br /> Owner: Ethel Badzinski Larry Lemon Buyer: John Dahlstrom <br /> Address:2770 County Rd A 2761 Counnt r Rd A Address: 2769 County Rd A <br /> Webster. WI 54893 Webster, WI 54893 Webster, WI 54893 z <br /> cA <br /> Phone: Phone: 715-296-0915 <br /> Original Parcel Information <br /> 07-028-2-40-14-20-5 05-003-012000 <br /> Parcel ID#: 07-028-2-40-14-20-5 05-()03-011000 Section-2Q—Township 4 N Range 14W <br /> Original Description(or attach copy): es <br /> Gov Lot 3 EX CSM V4 P271 & Ex CSM V13 P97& Ex CSM V13 P119 & Ex CSM V13 P180 <br /> & Ex E 660': E 660' of Gov Lot 3 <br /> Current Zoning: RR3 Floodplain Y/N:__N _Wetlands Y/N:_N Lake/River Class: - <br /> Name of Water Body: - Shoreland Agreement/SIPS Y/N: N . <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N: N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: New 1 lot and 1 Outlot CSM <br /> Acres: .99 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road:existing d <br /> m <br /> Proposed access to public waters to be provided Y/N:N n <br /> w.I <br /> If yes,describe access: <br /> N <br /> Signature of Owner. Date: <br /> Signature of Owner: Date: <br /> ➢ Does parcel meet Zoning Requirements. Yes No <br /> R, 7 /1 / q <br /> ➢ Does parcel require a Survey? Yes No _ <br /> Permit application fees submitted? ❑ Amount$ 3� Receipt# <br /> t., ❑Reconciles with Real Property Lister Yes No Date: <br /> m <br /> 0 <br /> If not,explain: <br /> 0 <br /> a <br /> y <br /> Application Approved ! enied Reason for Denial: <br /> No 1^9 S a /161 to cd o o L l o r OG 2- <br /> Land Use: Date: <br />