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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+$50.00/lot <br /> owner: Michael Waltzing Buyer: -0 <br /> eD <br /> Address:27220 Jamison Rd Address: <br /> T <br /> Webster WI 54893 <br /> o.0 <br /> c <br /> Phone: 715-566-1624 VID <br /> Phone: <br /> Original Parcel Information <br /> Parcel ID#: 07-020-2-40-16-31-5 05-004-012000 Section 31 Township 40N Range 16W CA <br /> C <br /> Pcl Gov Lot 4 <br /> Original Description (or attach copy): 0 <br /> m <br /> _3 <br /> -0 Current Zoning: RR1 Floodplain Y/N: Y Wetlands Y/N: Y Lake/River Class: <br /> L Name of Water Body: N/A Shoreland Agreement/SIPS Y/N: <br /> 0 <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N:N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: CSM <br /> Acres:2.68 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: p <br /> a: <br /> m <br /> Proposed access to public waters to be provided Y/N: "..0 <br /> If yes,describe access: <br /> Signature of Owner/2,6-C _< 4 4./(175-- <br /> Date: (,a ? a CO <br /> Signature of Owner: Date: 3 <br /> v <br /> > Does parcel meet Zoning Requirements? Yes No n 8/z2.)z2ya <br /> N <br /> ➢ Does parcel require a Survey? Yes No #6 'Z a 7 <br /> S• �� W <br /> Q4 01 <br /> ➢ Permit application fees submitted? 0 Amount$ Z�/ Receipt# <br /> dReconciles with Real Property Lister es No Date: q'tia„p <br /> 0 <br /> °- If not,explain: <br /> n <br /> 0 <br /> a. <br /> Applicatio . , ppro • . Denied Reason for Denial: <br /> Land Use: ! 3 2-0761 Date: <br />