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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+$50.00/lot <br /> Owner: M L Hoist LLC Buyer: <br /> Address: 852 138th St Address: <br /> Amery, WI 54001 <br /> Phone: 715-821-2150 Phone: <br /> Original Parcel Information <br /> Parcel ID#: 07-032-2-41-16-26-2 04-000-011000 Section 26 Township 41N Range 16W <br /> O <br /> Original Description(or attach copy): E 1/2 SE NW • 5. <br /> 3 <br /> Current Zoning: RR3 Floodplain YIN: N Wetlands Y/N: Y Lake/River Class: <br /> Name of Water Body: NA Shoreland Agreement/SIPS Y/N: N <br /> Farmland Preservation Y/N: N Managed Forestry Law YIN: N �• <br /> New Parcel Information (� <br /> Proposed New Legal Description and Parcel Size: CSM divide into 4 parcels <br /> Acres: 20.10 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> Proposed access to public waters to be provided YIN: <br /> If yes,describe access: <br /> Signature of Owner: /fC/^-- / o--- Date: )`i <br /> Signature of Owner: Date: <br /> ti <br /> Does parcel meet Zoning Requirements? Yes No get_ C/P/Zel <br /> N / C� <br /> Does parcel require a Survey? Yes No (p�/o / <br /> E. <br /> > Permit application fees submitted? ❑ Amount$ <br /> atd/ Receipt# <br /> ly Reconciles with Real Property Lister 010 No Date: 5-1-,x1310 <br /> If not,explain: <br /> Applicati ,Approved / Denied Reason for Denial: <br /> Land Use: `` .3/0-O?-61 Date: <br />