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y�J <br /> Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision ,v/o Survey: $50.00 <br /> and/or Pre-A lication Form Survey of Existing Parcel:: S50.00/lot <br /> PP Subdivision sv/Survev: $200.00+$50.00/lot <br /> Owner: Sylvia P aulus Buyer: <br /> Address: PO Box 368 <br /> Address: <br /> T <br /> Webster WI 54893 z <br /> 0 <br /> G <br /> Phone: 71 5-8 6 6-41 3 4 Phone: 3� <br /> Original Parcel Information <br /> 07-020-2-40-16- - - _ 0 <br /> Parcel ID#: 07-020-2-40-1 6-32-1 01 -000-Section�__Township 4ON Ranee 1 6W <br /> 013020 0 <br /> Original Description(or attach copy): NE NE Line ast of Gandy DancerTrail <br /> and south of Jeffries Landing Rd and SE NE line East of Gandy <br /> Dancer Trail � <br /> C <br /> Current Zoning: RR3 Floodplain Y/v: N Wetlands Y/N: Y Lake/River Class: N/A t� <br /> Name of Water Body:_ N/A Shoreland Agreement/SIPS Y/N: N b <br /> Farmland Preservation Y/N: N <br /> IVIanaged Forestry Law Y/iY: N <br /> New Parcel Information <br /> Proposes]New Legal Description and Parcel Size: Combine Lots 1 , 2 & 3 <br /> Acres: 43 .67 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> iProposed access to public road: Existing o <br /> Proposed access to public waters to be provided Y/v: N <br /> oa If yes, describe access: �l <br /> iC <br /> i <br /> co Signature of Orvner: Date: <br /> ignature of Owner: Date: n <br /> 0 <br /> Z <br /> > Does parcel meet Zoning Requirements? Yes No <br /> N � <br /> > Does parcel require a Survey? Yes rVo <br /> o W <br /> Q0 > Permit application fees submitted? ❑ Amount <br /> Receipt#(�O � <br /> y ❑ Reconciles with Real Property Lister Yes No Date: o <br /> v <br /> If not,explain: J <br /> n W <br /> I <br /> C <br /> Applicatio Approved enied Reason for Denial: <br /> Land Use: - RE Z Z�/ Date: <br />