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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+$50.00/lot <br /> Owner: ML Hoist LLC Buyer: <br /> b <br /> CD <br /> Address: 852 138th St Address: <br /> Amery WI 54001 <br /> t-d- <br /> Phone: 715-821-2150 Phone: <br /> Original Parcel Information • <br /> Parcel ID#: 07-024-2-39-14-31-4 04-000-011000 31 39N 14W <br /> Section Township Range <br /> SE-SE ex E.871'of N 100' 4 <br /> Original Description(or attach copy): a <br /> n <br /> n <br /> 3 <br /> r <br /> ma <br /> Current Zoning: A2 Floodplain Y/N: N Wetlands YIN: Y Lake/River Class: <br /> 5. Name of Water Body: Shoreland Agreement/SIPS YIN: cAP. Farmland Preservation Y/N: N Managed Forestry Law Y/N: N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: 3 lot CSM ��j <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: p <br /> m <br /> Proposed access to public waters to be provided Y/N: r' <br /> If yes,describe access: 4.. <br /> re <br /> - Signature of Owner: ,0,..„"- N Date: <br /> N <br /> Signature of Owner: Date: © <br /> ` a <br /> ! 'a <br /> (Two➢ Does parcel meet Zoning Requirements? Yes NoGs fJ` ° <br /> N <br /> o° ➢ Does parcel require a Survey? Yes Na Q€#G AS ti <br /> a •0 <br /> 0° fees submitted? 0 Amount$ �p <br /> application Receipt# 6' <br /> > Permit <br /> i 0 Reconciles with Real Property Lister Yes No Date: Ca <br /> a <br /> c- If not,explain: <br /> n <br /> n <br /> -, <br /> a. <br /> m <br /> ApplicationApprove Denied Reason for Denial: <br /> See, rewire MAP-Z2-03. <br /> Land Use: Date: <br /> 6 /0 ZO2-.Z_ <br />