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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+$50.00/lot <br /> Owner: ML Holst LLC Buyer: <br /> b <br /> CD <br /> Address: 852 138th St Address: B <br /> Amery WI 54001 �o <br /> Phone: 715-821-2150 <br /> Phone: <br /> Original Parcel Information <br /> Parcel ID#:07-002-2-37-19-23-2 03-000-01100R <br /> ection 23 Township 37 Range 19 <br /> Original Description(or attach copy): SW-NW ex S 8 rds W 22 rds <br /> a <br /> ›- ; <br /> n <br /> Current Zoning: RR3 Floodplain Y/N: N Wetlands Y/N: N Lake/River Class: <br /> n Name of Water Body: <br /> Shoreland Agreement/SIPS YIN: <br /> Farmland Preservation Y/N: N Managed Forestry Law YIN: N 1 <br /> New Parcel Information ���----- <br /> ]n <br /> Proposed New Legal Description and Parcel Size: 7 lots 2 csm's <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> a <br /> Proposed access to public waters to be provided Yam: if <br /> If yes,describe access: <br /> Signature of Owner: ,_ / Date: 6/14/24 <br /> Signature of Owner: Date: a' <br /> 8 <br /> > Does parcel meet Zoning Requirements? Yes No L ° <br /> 7 > Does parcel require a Survey? Yes No ` .. - 6O T b 9 <br /> ° of2hl <br /> cm > Permit application fees submitted? ❑ Amount$ <br /> Receipt# <br /> 0 Reconciles with Real Property Lister Yes No Date: <br /> a <br /> a <br /> c If not,explain: <br /> n <br /> a <br /> a <br /> a. <br /> y <br /> Applicati pproved / D nied Reason for Denial: <br /> c ` <br /> Land Use: ��,--..- - 6/0/ 040 Z V Date: <br /> lh5 /5 LIilh9 i I eis/ dJ //,0"1/6P4 <br />