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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+$50.00/lot <br /> Owner: Marion Obszarny Buyer: _c Coli /h l is <br /> b <br /> Address: 8542 Malone Dr Address: 5 <br /> Webster WI 54893 <br /> Phone: 6;cf-785-4 27 7 <br /> Phone: <br /> Original Parcel Information ,L <br /> 07-020-2-40-16-19-5 15-360-029000-042000, 051000,055000-060000 2 <br /> Parcel ID#: Section 19 Township 40N Range 16W <br /> O <br /> Original Description(or attach copy): Jensen's Lakeshore Div of Yellow Lake Lot 5-14 BIk 8 s <br /> ft <br /> Lot 7-20 BIk 5, Lot 8 BIk 7 <br /> Ib Current Zoning: RR1 Floodplain Y/N: Y Wetlands Y/N: N Lake/River Class: d <br /> n Name of Water Body: Yellow Lake Shoreland Agreement/SIPS Y/N: tr <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N:N N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: CSM <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: C7 <br /> Proposed access to public waters to be provided Y/N: FA <br /> yes,describe access: ‘411 - <br /> Ct <br /> Signature of Owner: 7/e�/'L (3AdjLe'-2.fZr' Date: 12/21/20 ` <br /> Signature of Owner: U�f Date: c <br /> a <br /> (9 <br /> D Does parcel meet Zoning Requirements? Yes No 0 Z <br /> a <br /> N <br /> c° ➢ Does parcel require a Survey? Yes No ,� <br /> Q° D. Permit application fees submitted? 0 Amount$ tf©1l ' Receipt# <br /> i V--'i <br /> t7 ISI Reconciles with Real Property Lister Yes No Date: ��,� o� ' <br /> aa 6� <br /> If not,explain: j` W <br /> ein <br /> o e. to <br /> N <br /> tr <br /> Applicatialr1 Approved /)enied Reason for Denial: <br /> Land Use / /007-- Date: <br />