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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/Survey: $200.00+$50.00/lot <br /> Owner: Robert Pardun Buyer: <br /> b <br /> Address:8645 Olsen Rd Address: <br /> Webster WI 54893 z <br /> 0 <br /> Phone: 715-866-7245 Phone: G <br /> W <br /> Orilinal Parcel Information <br /> ..p <br /> Parcel ID#: 07_016-9-39-17-11-1 04-0-011000 Section 11 Township3 9N Range 17W ` <br /> Original Description(or attach copy): NE 114 SE NE <br /> Current Zoning: RR3 Floodplain Y/N: N Wetlands Y/N: N Lake/River Class: <br /> pName of Water Body: Shoreland Agreement/SIPS Y/N: 0 <br /> Farmland Preservation Y/N:N Managed Forestry Law Y/N:N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: 10 acre lot to be split Into 5 acre lots <br /> Acres:10 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: C <br /> m <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: <br /> f <br /> Signature �Z '� �%� <br /> gn of Owner: � Date: <br /> Signature of Owner: Date: <br /> b <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> p ➢ Does parcel require a Survey? Yes No G 44- 601.0 <br /> � ti <br /> Permit application fees submitted? ❑ Amount$__ �� Receipt# (y� <br /> Q <br /> t ❑Reconciles with Real Property Lister Yes No Date: <br /> m <br /> O <br /> E If not,explain: <br /> A <br /> n <br /> O <br /> a <br /> Vl <br /> Applicati pproved / enied Reason for Denial: <br /> Land Use: Date: �Z O <br />