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Fees(nmst accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br /> and/or Pre-A lication Form Survey of Existing Parcel: $50.00/lot <br /> PP Subdivision w/Survev: $200.00+$50.00/lot <br /> Howard Van Vleet Owner: <br /> Owner: g4ox Thomas Plunket <br /> Address:7620 Entrance Rd Address: 7626 Entrance Rd = <br /> Webster, WI 54893 Webster, WI 54893 z <br /> 0 <br /> Phone: 651-302-0284 <br /> Phone: <br /> Original Parcel Information <br /> 07-020-2-40-16-20-5 15-931-024000&07-020-2-40-16-20-5 15-931-027000 <br /> Parcel ID#: Section 20 Township 40N Range 16W <br /> Original Description (or attach copy): Lot 3 CSM V17 P226(Village of Yellow Lake Assossor's Plat Frmly Prt Lot 12) <br /> &Village of Yellow Lake Assessor's Plat Lot 15 Blk 1 <br /> Current Zoning: RR1 Floodplain Y/N: Y Wetlands Y/N: N Lake/River Class: <br /> Name of Water Body: YeIIOW Lake Shoreland Agreement/SIPS Y/N: N <br /> Farmland Preservation Y/v: N Managed Forestry Law Y/N: N <br /> New Parcel Information `f <br /> Proposed New Legal Description and Parcel Size: Revise CSM of Lot 3 & Lot 15 <br /> Acres:2.63 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: 0 <br /> Proposed access to public waters to be provided Y/N: N <br /> 4 <br /> If yes, describe access: _3 <br /> Signature of Owner: �u�� �_ I/ �f !� Date: 17 <br /> Signature of Owner: n-r+� �iJC�V X/�� Date:5�/ <br /> 'a <br /> > Does parcel meet Zoning Requirements? Yes No <br /> N <br /> � > Does parcel require a Survey? Yes No <br /> 5• <br /> (r° i Permit application fees submitted? ❑ Amount S la) UO Receipt# <br /> ❑ Reconciles with Real Property Lister Yes No Date: m _ <br /> a O <br /> If not,explain: �W n <br /> ° Uuu <br /> C <br /> Applicatio Approve Denied Reason for Denial: <br /> Land Use 0 24f Date: <br />