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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br /> Survey of Existine Parcel: $50.00/lot <br /> and/or Pre-Application Form Subdivision w/Survey: $200.00+$50.00/lot <br /> owner: Roger Tollander Buyer: m <br /> Address: PO Box 587 Address: E <br /> Webster WI 54893 <br /> o€:, <br /> .to <br /> Phone: Phone: <br /> ti <br /> Original Parcel Information <br /> 07-018-2-39-16-08-2 03-000-012000 08 39 16 <br /> Parcel ID#: Section Township Range <br /> O <br /> Original Description(or attach copy): PCI SW-NW& SE-NW ex CSM V1 P287 & V324 P511 <br /> ro <br /> ( ii• <br /> Current /ming: 8` RR loo. : sin YIN: N Wetlands Y/N: N Lake/River Class: <br /> m Name of Water Body: ,'A Shoreland Agreement/SIPS Y/N: b---\ <br /> F. Farmland Preservation Y/N: N Managed Forestry Law Y/N: N <br /> New Parcel Information " <br /> Proposed New Legal Description and Parcel Size: CSM 2 lot divide <br /> Acres: D',3S <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> ie isi-iNg <br /> Proposed access to public waters to be provided Y6) <br /> If yes,describe access: V <br /> Signature of Owner: .1;e6 Date: 7/�7/z <br /> Signature of Owner: Date: o <br /> c <br /> > Does parcel meet Zoning Requirements? Yes No cfr___ 6O1s-7 <br /> z <br /> 0 Does parcel require a Survey? Yes No <br /> E. <br /> ct °�' <br /> °° P. <br /> Permit application fees submitted? ❑ Amount$ Receipt# <br /> r ® Reconciles with Real Property Lister Yes No Date: $/unia,i <br /> c <br /> 0 <br /> c If not,explain: <br /> f w <br /> o <br /> Application. Approved Denied Reason for Denial: <br /> Pqr 2,0,1 R - Z <br /> Land lise:yrte-te_...- .5/7_ 2(7a/ Date: <br />