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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 or Map Review Form Subdivision w/Survey: $200.00+$50.00/lot <br /> iv <br /> Owner y eb <br /> owner: John & Tammy Ingalls Trust : Lawrence Donovan & Ann Risvold e, S <br /> ti <br /> Address:27167 Engebretson Rd Address: 27165 John Stone Rd g o <br /> Webster WI 54893 Webster WI 54893 ,V�J <br /> q�q� <br /> Phone: Phone: `T' <br /> i <br /> Original Parcel Information ILi <br /> Tax ID#: 07-018-2-39-16-03-5 05-002-014000 section 03 Township 39N Range 16W ' -. <br /> 07-018-2-39-16-03-5 05-002-030000 <br /> Original Description(or attach copy): Lot 4 CSM V2 P54 & GL2 & 3 <br /> O <br /> 4 <br /> a <br /> to <br /> K <br /> Current P <br /> Zoning: RR1 Flood lain Y/N:Y Wetlands Y/N: N Lake/River Class- 6 <br /> Name of Water Body: Devils Lake Shoreland Agreement/SIPS Y/N: eAr <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N: N k <br /> New Parcel Information <br /> 0 <br /> Proposed New Legal Description and Parcel Size: 2 Lot CSM of existing parcels ) _ <br /> 1 <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe acce • -53 <br /> ",r�,,k,,; Yati # • A --. a l u,, P <br /> m� <br /> Fee Rec: / <br /> ➢ Does parcel meet Zoning Requirements? Yes No I Check#: / 9 e 95- <br /> ➢ Does parcel require a Survey? Yes No <br /> Reconciles with Real Property Lister Yes No Date: 40 <br /> If not,explain: 12 <br /> o <br /> Application: proved enied Reason for Denial. <br /> av <br /> Land U Date: <br />