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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> and/or Pre-Application Form or MapReview Form Subdivision w/o Survey: $50.00 <br /> pp Survey of Existing Parcel: $50.00/lot <br /> Subdivision w/Survey. $200.00+$50.00/lot <br /> Vicki Fischbach / Jerry Summer <br /> Owner: Buyer: n <br /> 9 <br /> Address: 24354 Anchor Inn Road Address: a <br /> Webster, WI 54893 z <br /> o,th. <br /> c <br /> Phone: 349-5118 Phone: 7 <br /> �' <br /> Original Parcel Information <br /> Parcel ID#: 014220801100 Section 8 Township 38 Range 15 <br /> Original Description(or attach copy): Parcel described in Quit Claim Deed, Document No. <br /> 413100, located in Gov. Lot 4, T38N-R15W, see attached. <br /> RR-1 N/Ati: <br /> Current Zoning: Floodplain Y/N: N Wetlands Y/N: _ N Lake/River Class: <br /> Name of Water Body: Bass Lake Shoreland Agreement/SIPS Y/N: N <br /> Farmland Preservation YIN: N Managed Forestry Law Y/N: N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: A CSM is used to divide the existing parcel <br /> into 2 lots. One with the existing house of 1.71± acres and a vacant lot of 20.01± acres. <br /> Acres: 1.71± and 20.01± <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> Direct access to Anchor Inn Road <br /> Proposed access to public waters to be provided Y/N: N v <br /> If yes,describe access: <br /> Signature of Owner: �J1 41,1...A..,..„7 -4------ Date: 7/ e <br /> n <br /> signature or owner: Late: 7, Cyt'' <br /> © <br /> a <br /> ➢ Does parcel meet Zoning Requirements? Yes No IR e q lZp'lZ•. fD9 <br /> N ➢ Does parcel require a Survey? Yes No <br /> a <br /> a <br /> o \ <br /> = ➢ Permit application fees submitted? 0 Amount$ 'ICY receipt# L to v , , <br /> ' <br /> ® Reconciles with Real Property Lister CI, No Date: -ZA "20 <br /> a If not,explain: <br /> aa <br /> a <br /> c, Application: ,pprove Denied Reason for Denial: D <br /> Land Use: Q /#020 Date: , i <br /> / i i Ste° 020 <br /> 282 <br /> Burnett County <br /> Land Services Department <br />