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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+$50.00/lot <br /> Owner: ML Holst LLC Buyer: <br /> b <br /> Address: 852 138th St Address: <br /> Amery WI 54001 0 <br /> Phone: 715-821-2150 G <br /> Phone: 170 <br /> Original Parcel Information <br /> Parcel ID#: 07-0.18-2-39-16-35-4 01-000-016000 Section 35 Townshi 3p 9N Range 16W <br /> y <br /> Original Description(or attach copy): Poi NE-SE - Pt <br /> A <br /> ri <br /> Current Zoning: RR1 Flood plain lain YIN: NN r <br /> P Wetlands YIN: Lake/River Class: <br /> a Name of Water Body: N/A Shoreland Agreement/SIPS Y/N: °' <br /> '. Farmland Preservation Y/N: N Managed Forestry Law Y/N: N 1 <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: 2 Lot CSM <br /> Acres: 4.96 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> a <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: pC� <br /> Signature of Owner: ,i0 i Date: 9/7/23 E- <br /> Signature of Owner: Date: <br /> o <br /> 6 <br /> > Does parcel meet Zoning Requirements? Yes No / ° <br /> N Does> parcel require a Survey? r. <br /> ���SSo <br /> asY• Yes No <br /> od <br /> cm `> Permit application fees submitted? 0 Amount$ 3•QQ, ' Receipt# <br /> t1� <br /> ❑Reconciles with Real Property Lister Yes No Date: <br /> 5 <br /> c If not,explain: Uul <br /> 0 <br /> C <br /> c Zc. <br /> Applicati . Approved / nied Reason for Denial: <br /> _ p <br /> Land Use: 7 c — Date: / JO z3 <br /> 1 <br />