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Fees(must accompany form): <br /> Burnett Comity Subdivision Permit Application Subdivision w/o Survey: $50.00 <br /> S•;rvey of Existing Parcel: $50.00/lot <br /> and/or Pre-Application Form Lisionw/Survey 5200.00+$50.00/lot <br /> Owner: ML Holst LLC Buyer: ,v <br /> Address: 852 138th St Address: 3 <br /> 1Amery WI 54001 p <br /> Phone: C. <br /> 715-821-2150 411 <br /> Phone: <br /> iv <br /> Original Parcel Information i. <br /> Parcel ID#: 07-018-2-39-16-33-1 04-000-011000 Section 33 Township 39N Range-16W • <br /> O <br /> Original Description(or attach copy): SE-NE <br /> 0 <br /> n <br /> r <br /> •a Current Zoning: RR2 Floodplain Y/N: N Wetlands Y/N: N Lake/River Class: <br /> a Name of Water Body: N/A Shoreland Agreement/SIPS Y/N: N <br /> 0 <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N: N <br /> r <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: 2 CSM's 8 lots <br /> Acres: 40 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> P uposed access to public road: t7 <br /> Proposed access to public waters to be provided Y/N: <br /> OJL <br /> If yes,describe access: j/ <br /> Signature of Owner: fieN'-- Nt ' Date: 10/8/21 <br /> Signature of Owner: Date: o <br /> L <br /> a <br /> > Does parcel meet Zoning Requirements? Yes No C.i #lj,o9 93 <br /> N <br /> > Does parcel require a Survey? Yes No <br /> cm <br /> 00 <br /> Permit application fees submitted? 0 Amount$ 8'00 r Receipt# t„1 <br /> l .Reconciles with Real Property Lister Ora) No Date: ‘ii 1 j/_ i <br /> If not,explain: <br /> N <br /> 0 <br /> el <br /> L,, <br /> Application: 6 pproveSA,nied Reason for Denial: <br /> Land Use: ) //36/2....0?./ Date: <br />