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Fees(must accompany fomi): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br /> and/or Pre-A lication Form SurveyofExistingParcel: $50.00/lot <br /> PP Subdivision w/Survev: $200.00+$50.00/lot <br /> Owner: Sylvia Paulus Buyer: <br /> Address: PO Box 368 f9 <br /> Address: <br /> T <br /> Webster WI 54893 a <br /> ty� <br /> Phone: 71 5-866-41 34 Phone: <br /> Original Parcel Information 'D <br /> 07-020-2-40-16- - <br /> Parcel ID#: 07-020-2-40-1 6-32-1 01 -OOO,section TO <br /> _Township 4ON Range 1 6W <br /> 01 30EQ0 0 <br /> Original Description(or attach copy): NE NE Line ast of Gandy DancerTrai 1 <br /> and south of Jeffries Landing Rd and SE NE line East of Gandy <br /> Dancer Trail K� <br /> C <br /> Current Zoning: RR_ Floodplain Y/v: N Wetlands Y/N: V Lake/River Class: N/A <br /> o <br /> Name of Water Body: N/A Shoreland Agreement/SIPS Y/N: N b <br /> T Farmland Preservation Y/v: N Managed Forestry Law YN: N <br /> New Parcel Information <br /> Proposed 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 <br /> n — <br /> C <br /> i Proposed access to public waters to be provided YN: N <br /> cb If yes, describe access: <br /> i <br /> cap � Signature of Owner: Date: <br /> Si-nature of Owner: Date: n <br /> Z <br /> > Does parcel meet Zoning Requirements? Yes 1vo <br /> T <br /> N <br /> $ > Does parcel require a Survey? Yes Jvo _ <br /> o W <br /> Permit application fees submitted? ❑ Amount$ `0 <br /> ��Q— Receipt# <br /> t. ❑ Reconciles with Real Property Lister Yes No Date: <br /> v <br /> If not,explain: �l <br /> n <br /> o V,1 <br /> c. <br /> Applicatio Approved enied Reason for Denial: <br /> Land Use: -- Z Z 2,0/ Date: <br />