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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: 5200.00+$50.00/lot <br /> Owner: ML Holst LLC Buyer: <br /> -a <br /> ro <br /> Address: 852 138th St Address: 3 <br /> Amery WI 54001 <br /> iii.1 <br /> Phone: 715-821-2150 ty <br /> Phone: <br /> Original Parcel Information Pa <br /> Parcel ID#: 07-018-2-39-16-33-4 01-000-011100 Section 33 Township 39N Range 16W <br /> Original Description(or attach copy): NE-SE ex 2 rods <br /> N <br /> 3 <br /> r <br /> Current Zoning: RR2 Floodplain Y/N: N Wetlands Y/N: N Lake/River Class: cF-- <br /> Name of Water Body: N/A Shoreland Agreement/SIPS Y/N: u h- <br /> CJ <br /> R Farmland Preservation YIN: N Managed Forestry LawY/N: N rt. <br /> New Parcel Information �A <br /> Proposed New Legal Description and Parcel Size: 2 G7/Vl . <br /> E <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: O <br /> Proposed access to public waters to be provided Y/N: J <br /> If yes,describe access: —. <br /> k,.- <br /> 7/1/22 <br /> Signature of Owner: e." Date: <br /> IA <br /> Signature of Owner: Date: No <br /> S <br /> -a <br /> a <br /> > Does parcel meet Zoning Requirements? Yes No 01 $6061 -2----i / <br /> N <br /> a > Does parcel require a Survey? Yes No <br /> VI <br /> o° > Permit application fees submitted? 0 Amount$ 'DDI D� Receipt# <br /> 0 Reconciles with Real Property Lister Yes No Date: <br /> a <br /> c- If not,explain: <br /> UI <br /> e.n <br /> n <br /> 0 <br /> ,-s <br /> C. <br /> m <br /> Application: fr ''rov•, Denied Reason for Denial: <br /> Land Use: Date: 7 f9 24v ZZ_ <br />