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.ter <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 ofEristin;Parcel: $50.00/lot <br /> PP Subdivision/Survev: $200.00+$50.00/lot <br /> Owner: __Sylvia P aulus Buyer: "Z <br /> Address: PO Box 368 Address: <br /> Webster WI 54893 z <br /> 0 <br /> Phone: 71 5—8 6 6—41 3 4 Phone: 3� <br /> Original Parcel Information <br /> 07-020-2-40-16— — — <br /> c <br /> Parcel ID#: 07-020-2-40-1 6-32-1 01 —000-Section__3_2_Township 40N Range 1 6W <br /> 013620 <br /> g P � <br /> Original lion(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 Yam: N Wetlands Y/N: Y Lake/River Class: N/A to <br /> Name of Water Body: N/A Shoreland Agreement/SIPS Y/N: N b <br /> Farmland Preservation Yam: N <br /> Managed Forestry Law Y/N: 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 /> Proposed access to public road: Existing <br /> �7 <br /> nW �_ <br /> Proposed access to public waters to be provided Y/N: N <br /> oIf yes, describe access: Aj <br /> 01 <br /> Dco � Signature of Owner: Date: <br /> s <br /> + ©Si-nature of Owner: Date: n <br /> 0 <br /> 'Q <br /> > Does parcel meet Zoning Requirements? Yes No <br /> N � <br /> > Does parcel require a Survey? Ye No <br /> � W <br /> Permit application fees submitted? ❑ Amount S <br /> �"jQ`� Receipt� <br /> ❑ Reconciles with Real Property Lister Yes No Date: o <br /> v <br /> If not,explain: v <br /> o u► <br /> c <br /> Applicatio Approved Aenied Reason for Denial: <br /> Land Use: - g Z Z�/ Date: <br />