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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+$50.00/lot <br /> Morris Hoist <br /> Owner: Buyer: „4 <br /> Address: 852 138th St Address: <br /> Amery, WI 54001 0 <br /> c <br /> Phone: Phone: Q <br /> Original Parcel Information <br /> Parcel ID#:07-026-2-39-15-23-3 03-000-011000,02-000-014000 Section 23 Township 39N Range 15W44, <br /> O� <br /> Original Description(or attach copy): SW-SW, NW-SW ex CSM V12 P25&CSM V12 P27&ex PcI Desc#331058 <br /> 5 <br /> 's <br /> 3 <br /> UnZane_a/ a <br /> Current Zoning: Unknown Floodplain YIN: N Wetlands Y/N: Y Lake/River Class: <br /> "c VliName of Water Body: N/'4 Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation YIN: N Managed Forestry Law YIN: N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: CSM dividing existing parcel <br /> Acres: /0,7 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: Pri✓4f t Li 7' <br /> n <br /> Proposed access to public waters to be provided YO <br /> �� <br /> If yes, describe access: <br /> Signature of Owner: 7ga'" Date: yl17b- <br /> Signature of Owner: Date: o <br /> ( c <br /> > Does parcel meet Zoning Requirements? Yes Na Ace— 9/7}/ /YJ n <br /> > Does parcel require a Survey? Yes No G/c—+ lv e& 3 7 <br /> a" > Permit application fees submitted? ❑ Amount$ 1.74a)11O Receipt# <br /> / 6' <br /> r H Reconciles with Real Property Lister es No Date: q-2,8-2.02.0 <br /> ra <br /> s <br /> c. If not,explain: <br /> (11 <br /> 0 <br /> C <br /> . <br /> Application. Approved 1__benied Reason for Denial: <br /> Land Use: — _ r2J/ Z2t9 Date: <br />