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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br /> and/or Pre-A lication Form Survey Existing Parcel: 0 lot <br /> pp Subdivision w/Survev: $200.00+$50.00/lot <br /> Owner: Kenneth Aderman Buyer: <br /> .ti <br /> Address:26155 Thoma Rd Address: <br /> Webster WI 54893 z <br /> 0 <br /> G <br /> Phone: Phone: <br /> Orizinal Parcel Information Al <br /> Parcel ID#: 07-016-2-39-17-15-4 01-000-011000 Section 15 Townshi 3p 9N Range 17W <br /> Original Description(or attach copy): NE SE <br /> a Current Zoning: A2 Floodplain Y/N: Y Wetlands Y/N: Y Lake/River Class: <br /> Name of Water Body: Shoreland Agreement/SIPS Y/N: <br /> a <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N:N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: CSM split existing �> <br /> _S `/2 e --5 /V 2 - O,(rc of <br /> Acres: 1 ate` <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: C7 <br /> a� <br /> Proposed access to public waters to be provided Y/N: •�-.. <br /> If yes,describe access: <br /> Signature of Owner: Date: <br /> Signature of Owner: Date, c <br /> 3 <br /> p g q DEC 0 2019 <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> ➢ Does parcel require a Survey? Yes No <br /> a Burnett County <br /> Permit application fees submitted? ❑ Amount$ Land§ggC4ftQepartrnent <br /> �. econciles with Real Property Lister <LY No Date: Z ZO k1 <br /> v <br /> Q- If not,explain: IVY %a <br /> 7� <br /> 0 <br /> -s <br /> Application: pproved / Denied Reason for Denial: <br /> Land Use: /Z ZO l• Date: <br />