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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+$50.00/lot <br /> Owner: Scott& Karen Guenard Buyer: ,ti <br /> re <br /> Address: 30032 Upland Woods Ct Address: R. <br /> Webb Lake, WI 54830 <br /> 218-391-9947 (Scott) 218-393-9870K <br /> Phone: Phone: (Karen) <br /> Original Parcel Information kk► <br /> 07-012-2-40-15-13-5 15-124-101000 <br /> Parcel ID#: 07-012-2-40-15-13-5 15-124-102000 Section 13 Township 40N Range 15W <br /> O <br /> Original Description(or attach copy): Deer Lodge Add to W Lots 94&95 <br /> ei <br /> v Current Zoning: PUD Floodplain Y/N: N Wetlands Y/N: Y Lake/River Class: <br /> = N/A <br /> aName of Water Body: Shoreland Agreement/SIPS Y/N: <br /> T Farmland Preservation Y/N: N Managed Forestry Law YIN: N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: CSM combine Lots <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: Treasure island Rd t7 <br /> m <br /> Proposed access to public waters to be provided Y/N: N <br /> n O. <br /> If yes,describe access: <br /> ^g,.. <br /> Ggn . AWN' Gi't,1i1i_ Dom: 1-31-2023 <br /> Signature of Owner: Date: el <br /> 3 <br /> > Does parcel meet Zoning Requirements? Yes No / <br /> P g 4 607579 <br /> ti <br /> > Does parcel require a Survey? Yes No <br /> cni > Permit application fees submitted? 0 Amount$ �� Receipt# <br /> F <br /> 1 <br /> ©Reconciles with Real Property Lister No Date: 2-1(0-,23 'Mr <br /> o <br /> a. If not,explain: <br /> o <br /> n <br /> 0 <br /> C. <br /> Application. Approved Denied Reason for Denial: <br /> Land Use: i ,/2--//e-o Z 3 Date: <br />