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Fees(must accompany form): <br /> Burnett.County Subdi ision Permit Application Subdivision w/o Survey: $50.00 <br /> Survey of Existing Parcel: $50.00/lot <br /> and/or Pre- pplication Form Subdivision w/Survey: S200.00+$50.00/lot <br /> Owner: ML Holst LLC Buyer: b <br /> Address: 852 138th St Address: 26'. <br /> Amery WI 54001 <br /> 715-821-2150 G <br /> Phone: Phone: . 4 <br /> Original Parcel Information N <br /> Parcel ID#: 07-008-2-38-14-06r5 05-001-011000 Section 06 Township 38N Range 14W <br /> Original Description(or attach copy: <br /> GL 1 03 <br /> a <br /> r <br /> Current Zoning: Floodplsjin Y/N: N Wetlands Y/N: N Lake/River Class: <br /> A <br /> Name of Water Body: Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N: N <br /> New Parcel Information r <br /> / <br /> Proposed New Legal Description an Parcel Size: <br /> 2 lot CSM ! /^ Z-- <br /> Acres: <br /> (If parcel is to be surveyed,provide p eliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: 0 <br /> Proposed access to public waters to b provided Y/N: <br /> If yes,describe access: <br /> Signature of Owner: ge,"-` 4+ Date: b <br /> Signature of Owner: Date: a <br /> I a <br /> /',��,� <br /> > Does parcel meet Zoning Requirem l nts? Yes No �...svti0 c <br /> oN / � <br /> > Does parcel require a Survey? Yes No arg! <br /> P° > Permit application fees submitted? 0 Amount$(�J E. " • Receipt# <br /> r 0 Reconciles with Real Property List I r Yes No Date: <br /> a <br /> c. If not,explain: <br /> n <br /> n <br /> 0 <br /> r <br /> C <br /> Application: •pproved 0 enied )season for Denial: <br /> Land Use: <br /> 4 /.:;:5/ k7Z-Z Date: <br />