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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+$50.00/lot <br /> Owner: ML Holst LLC Buyer: <br /> b <br /> Address: 852 138th St Address: 4 <br /> Amery WI 54001 z <br /> 715-821-2150 <br /> Phone: Phone: <br /> 07-030-2-38-16-12-2 02-000-011000 Original Parcel Information 1 - <br /> 07-030-2-38-16-12-2 01-000-011000 (,� <br /> 07-030-2-38-16-12-2 03-000-011000 <br /> Parcel ID#: Section 12 Township 38N Range 16W <br /> Original Description(or attach copy): SW-NW lying E of Town road,NW-NW lying E of Town road,NE-NW a <br /> m <br /> 3 <br /> r <br /> A2/Density development <br /> Current Zoning: Floodplain YIN: N Wetlands Y/N: V' Lake/River Class: t <br /> Name of Water Body: N/A Shoreland Agreement/SIPS YN: CA <br /> a <br /> Farmland Preservation YN: N Managed Forestry Law YN: N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: 8 Lot CSMs E <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: C <br /> Proposed access to public waters to be provided UN: • <br /> If yes,describe access: <br /> Signature of Owner: J7 ` / r,L.-'_ Date: 3/26/24 <br /> Signature of Owner: Date: n <br /> o <br /> 4 <br /> > Does parcel meet Zoning Requirements? Yes No L ° <br /> 5N GD�Iv�➢ Does parcel require a Su vey? Yes No <br /> a' p _ Q <br /> Q° > Permit application fees submitted? 0 Amount$ o�� Receipt# <br /> 0 Reconciles with Real Property Lister Yes No Date: <br /> RI <br /> c If not,explain: Q <br /> { 1 <br /> n <br /> CI <br /> © <br /> y `e, <br /> Applicatio I ved / D nied Reason for Denial: <br /> N3 <br /> Land Use: �� •-- 0 7-ea Date: <br /> //4l,s q>^�` /s Z�NP d .A'Z, (Ilsru7 s/ / �C%V�//o��'t�ff�I/ <br /> ��'sell , �f�/ or (10 Qcv,s, you /�o!o u� 9 <br /> P rS '5g /n7so eCI T /e m <br /> �o fS. �i►l l i <br />