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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/Survev: $200.00+$50.00/lot <br /> Owner: ML Hoist LLC Buyer: b <br /> CD <br /> Address: 852 138th St <br /> P.Address: <br /> Amery WI 54001 <br /> 0 <br /> ik <br /> Phone: <br /> Phone: iilP <br /> Original Parcel Information <br /> Parcel ID#: 07-026-2-39-15-35-4 01-000-011000 Section 35 Township 39N Range 15W 'v <br /> Original Description(or attach copy): NE-SE a <br /> m <br /> 3 <br /> r <br /> .> Current Zoning:Unzoned Floodplain Y/N: N Wetlands Y/N: N Lake/River Class: <br /> -a <br /> Fr <br /> Name of Water Body: N/A Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation YIN: N Managed Forestry Law Y/N: N <br /> New Parcel Information Jr- <br /> CI <br /> Proposed New Legal Description and Parcel Size: 2 CSM 8 lots <br /> Acres: 40 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: d <br /> m <br /> Proposed access to public waters to be provided Y/N: `d <br /> If yes,describe access: -g <br /> //,•-• <br /> / -- � --�-\ <br /> Signature of Owner: goo— Date: <br /> Signature of Owner: Date: o <br /> 6 <br /> r <br /> Does parcel meet Zoning Requirements? Yes No 6O 36 �,' <br /> / -` <br /> > Does parcel require a Survey? Yes No Z GS/YI-s <br /> a <br /> E. Q� <br /> °q > Permit application fees submitted? 0 Amount$ U °Q 1 o� Receipt# <br /> r. <br /> El Reconciles with Real Property Lister ® No Date: 7/9/a,\ <br /> a. If not,explain: <br /> n <br /> , <br /> n <br /> 0 <br /> 0. <br /> ti <br /> Application � may'I enied Reason for Denial: <br /> Land Use: 0 7/// 7-61e--/ Date: <br />