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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,v/Survey: S200-00 t,$50.00/tot <br /> Owner <br /> Owner: Ger Rental Properties Gerald Best b <br /> Address:2848 County Rd A Address: 3034 County Rd A <br /> Webster WI 54893 Webster WI 54893 0 <br /> 715-635-7371 <br /> Phone: Phone: Ep <br /> Original Parcel Information <br /> 07-028-..230-14-195 05-006-021000 Parcel ID#• 07-023-240-14-19-505�OOG023100 07-023-2-40-14-19-505-OO&M000 Section 19 Township 40N Range 14•"�(�/ <br /> Original Description(or attach copy): Lot 1 csMaasz vza P214 9419e16(GL3,5a6) S" <br /> ro <br /> Lot 1 CSM V16 P217(Frrnly prt CSM V16 P153 in Gov Lot 6) Lot 2 CSM V16 P217(Lnniy prt of CSM V16 P153 Gov Lot 6) <br /> Current Zoning: RR3 Flaodplain YIN: N Wetlands Y/N: N Lake/River Class: <br /> Name of Water Body: N/A Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation Y/N:N Managed Forestry Law Y/N:N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: Modified 2 lot CSM <br /> Acres:2.20 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: b <br /> s� <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: <br /> Signature of Owner: �" Date: <br /> Signature of O Date: <br /> a <br /> c <br /> ➢ Does parcel meet Zonin,,Requirements? Yes No <br /> z <br /> N <br /> y Does parcel require a Survey? Yes 11 No _ <br /> Q Permit application fees submitted? 0 Amount$ l 00� Re e pt# 0(3 <br /> V_a <br /> t, 0 Reconciles with Real Property Lister Yes No Date: <br /> CL If not,explain_ <br /> o FRJE `V� 0 <br /> a. <br /> Applicatio • pproved / nied Reason for Denial: <br /> I <br /> Burnett County <br /> Land Use: 7iZ 7�Oz0 Date L SeFY., .,Department <br />