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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br /> and/or Pre-A lication Form Survey of Existing Parcel: $50.00/lot <br /> PP Subdivision w/Survey: S200.00+$50.00/lot <br /> Owner: ML Holst LLC Buyer: <br /> Address: 852 138th St Address: <br /> Amery WI 54001 <br /> 0 <br /> Phone: 715-821-2150 C <br /> Phone: CO <br /> Original Parcel Information k,ki <br /> 07-040-2-39-19-32-1 01-000-011000 32 39N 19W <br /> Parcel ID#: Section Township Range oo <br /> Original Description(or attach copy): NE-NE, SE-NE <br /> eD <br /> 3 <br /> r <br /> Current Zoning: RR3 Floodplain YN: N Wetlands Y/N: N Lake/River Class: <br /> = Name of Water Body: Shoreland Agreement/SIPS YN: <br /> Farmland Preservation YN: N Managed Forestry Law YN: N <br /> New Parcel Information r <br /> Proposed New Legal Description and Parcel Size: CSM <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: c7 <br /> Proposed access to public waters to be provided Y/N: tt <br /> If yes,describe access: t•-- . <br /> li <br /> Signature of Owner: 71 eis-_ 1V�,C'L--- Date: 9/6/22 <br /> Z, <br /> Signature of Owner: Date: 2 <br /> -o <br /> > Does parcel meet Zoning Requirements? Yes No <br /> N G 0657 <br /> 3 > Does parcel require a Survey? Yes No <br /> a ap VV <br /> °0 > Permit application fees submitted? 0 Amount$ V.001 Receipt# <br /> V4 <br /> rRI Reconciles with Real Property Lister es No Date: I0/3/aa C <br /> E C\ <br /> c. If not,explain: <br /> et <br /> n <br /> 0 <br /> Application. A proved enied Reason for Denial: <br /> Land Use: % — /4/�ZZate: <br /> 1 <br />