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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+$50.00/lot <br /> Owner: Premier Materials LLC Buyer: it <br /> a <br /> Address:27692 State Rd 35 Address: i. <br /> Webster WI 54893 <br /> 0 <br /> Phone: Phone: <br /> Original Parcel Information <br /> Parcel ID#: 07-020-2-40-16-28-3 03-000-011000 Section 28 Township 40N Range 16W s <br /> Original Description(or attach copy): SW-SW Ex PCL V217 P497-499 & Ex CSM V17 P159 i <br /> to2 <br /> RI <br /> v Current Zoning: 11 Floodplain Y/N: N Wetlands YIN: N Lake/River Class: T° <br /> b <br /> a: <br /> a Name of Water Body: N/A Shoreland Agreement/SIPS YIN, <br /> Farmland Preservation YIN:N Managed Forestry Law Y/N:N <br /> New Parcel Information <br /> c <br /> Proposed New Legal Description and Parcel Size: CSM r <br /> F <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: C <br /> 8 <br /> A <br /> Proposed access to public waters to be provided YIN: •;_., <br /> �\ <br /> If yes,describe access: <br /> Signature of Owner: fit i , Date: 9'/8' 20 <br /> Signature of Owner: Date: c <br /> 5 <br /> > Does parcel meet Zoning Requirements? Yes No a/.1 60 Z(7 c <br /> 7 <br /> ii <br /> > Does N. parcel require a Survey? Yes No • <br /> craQO W <br /> Permit application fees submitted? 0 Amount$ �/ ' Receipt# ,J <br /> -0 <br /> I W <br /> � Cil Reconciles with Real Property Lister CD No Date: 11110 2(j <br /> a <br /> a. If not,explain: <br /> a <br /> a <br /> 0 <br /> a <br /> H <br /> Application: iltn ci—Pe Denied Reason for Denial: <br /> - r2-240 Ae— MA '-20-493 <br /> Land Use: • 3 _1 1 Date: <br />