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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: $200.00+$50.00/lot <br /> Owner: ML Hoist LLC Buyer: <br /> C, <br /> Address: 852 138th St Address: 3 <br /> 1 R <br /> Amery WI 54001 <br /> 715-821-2150 C.Phone: Phone: <br /> Original Parcel Information i <br /> 07-024-2-39-14-08-1 01-000-011000 <br /> Parcel ID#: 07-024-2-39-14-09-2 02-000-011000 Section 08/09 Township 39N Range 14W . '`' <br /> Original Description(or attach copy): S08-NE-NE, S9 NW-NW <br /> n <br /> n <br /> 3 <br /> r <br /> Current Zoning: A2 Floodplain Y/N: Y Wetlands Y/N: Y Lake/River Class: i <br /> o Name of Water Body: Gaslyn Creek Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N: N <br /> Ne rm a tion <br /> Proposed New Legal Description and Parcel 1ZeFlots CSMs r <br /> Acres: 80 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: d <br /> i <br /> Proposed access to public waters to be provided YIN: <br /> • <br /> If yes,describe access: <br /> Cr <br /> Signature of Owner: �CN`-. N/c2 -- 6/30/23 <br /> Date: V1 <br /> Signature of Owner: Date: (,:'.1 <br /> 9 <br /> D Does parcel meet Zoning Requirements? Yes No ° <br /> N C,t&- aS)1� it <br /> V ➢ Does parcel require a Survey? Yes No <br /> o ryr.1 ye' <br /> Q° > Permit application fees submitted? 0 Amount$ I(9 r Receipt# i' <br /> p ,,/ °1 <br /> 0 Reconciles with Real Property Lister����Yes ) No Date: //��,uj <br /> 01, <br /> If not,explain: --�J I 6 �\W <br /> n <br /> -oi <br /> 0. <br /> 81 'LI <br /> Applicatio i• Approved / D• ied Reason for Denial: <br /> Land Use: Date: /s/ 0ea M U <br /> IA I's I S u s iwty /ik c .5/ <br /> de,veisor At eA4/ 1t9 vi s 1 v o <br /> N ,d /4.z e O D aCr/e, = 2 /49 /S <br />