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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> and/or Pre-Application Form or Map Review Form Subdivision w/o Survey: $50.00 <br /> Survey of Existing Parcel: $50.00/lot <br /> Subdivision w/Survey: $200.00+$50.00/lot <br /> Bruce Stariha <br /> Owner: Buyer: <br /> Address: 26890 HOPKINS ROAD Address: <br /> WEBSTER WI 54893 0 <br /> 612-990-1278 <br /> Phone: Phone: <br /> Original Parcel Information <br /> Parcel ID#: 026320605400 & 026320605500 Section 6 Township 39 Range 15 <br /> Original Description(or attach copy): Parcels 16 & 17, of Survey filed as D-893, described <br /> in Doc. No. 457426 in Gov. Lot 12-39-15. <br /> RR-1N/A (� <br /> Current Zoning: Floodplain Y/N: N Wetlands Y/N: N Lake/River Class: <br /> .o Name of Water Body: Austin Lake Shoreland Agreement/SIPS Y/N: ? <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N: N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: This CSM merges two existing parcels <br /> into one lot. <br /> Acres: 0.89± <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Hopkins Road <br /> Proposed access to public road: <br /> Proposed access to public waters to be provided Y/N: N <br /> l7 <br /> If yes,describe access: <br /> Signature of Owner: N/A Date: t <br /> signature of owner: Date: ° <br /> c <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> O'4 <br /> ➢ Does parcel require a Survey? Yes No r-- <br /> ,. <br /> _ <br /> S ➢ Permit application fees submitted? ❑ Amount$ Receipt# <br /> ❑ Reconciles with Real Property Lister Yes No Date: <br /> aIf not,explain: -�!?- <br /> aec <br /> _fl <br /> vl <br /> 0 <br /> Q Application: Denied Reason for Denial: <br /> Land Use: - ? ooze Date: <br />