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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: $200.00+$50.00/lot <br /> Owner: Morry Hoist Buyer: <br /> C <br /> CD <br /> Address: 852 138th St Address: P <br /> Amery, WI 54001 p. <br /> Phone: G <br /> Phone: <br /> Original Parcel Information <br /> 07-010-2-38-19-03-4 03-000-011000 ' <br /> Parcel ID#: Section 03 Township 38N Range 19W <br /> Original Description(or attach copy): SW-SE - 5, <br /> Current Zoning: RR3 Floodplain Y/N: N Wetlands Y/N: N Lake/River Class: O <br /> R. <br /> a Name of Water Bod N/A <br /> y: Shoreland Agreement/SIPS YIN: <br /> Farmland Preservation Y/N: N Managed Forestry Law YIN: N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: 2 CSM divide into 8 Lots <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: i;7 <br /> a <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: <br /> Signature of Owner: fe,(M lVd'_ Date: 12/29/20 ^- <br /> Signature of Owner: Date: o <br /> a <br /> > Does parcel meet Zoning Requirements? Yes No 4...,,,,k- 667/37/ a <br /> N 9 <br /> > Doesparcel require a Survey? �� �2ZO ZO <br /> a 9 y Yes Na <br /> cm > Permit application fees submitted? 0 Amount$ S/00 ' Receipt# pp <br /> 00 <br /> lel Reconciles with Real Property Lister & No Date: 1/8/2021 <br /> o <br /> rz <br /> �' If not,explain: <br /> n <br /> a <br /> a9 <br /> c <br /> tA <br /> Ap lication Approved / e ied Reason for Denial:L • <br /> tJ4Ita9 eKsi C C D w e.N. . m),Si'e&A <br /> Land Use: P //00Z <br /> _� Date: <br />