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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br /> and/or Pre-Application Form Survey of Existing Parcel: $50.00/lot <br /> pP Subdivision w/Survey: $200.00+$50.00/lot <br /> 1 <br /> Owner: Morry Hoist <br /> Buyer: <br /> Address: 852 138th St Address: <br /> VI <br /> Ame ly, WI 54001 <br /> Phone: i Phone: 1 <br /> Original Parcel Information <br /> IS <br /> Parcel ID#: 07-040-2-39-19-27-2 02-000-011000 p� <br /> Section 27 Township 39N Range 19W 6S' <br /> Original Description(or attach copy): NW-NW f <br /> 3 <br /> Current Zoning:, RR3 Floodplain Y/: N Wetlands YIN: N p <br /> Lake/River Class: <br /> Name of Water Body: N/A Shoreland Agreement/SIPS Y/N: <br /> i <br /> Farmland Preservation YIN: N Managed Forestry Law YIN: N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: <br /> 2 CSM divide into 8 Lots `'� <br /> Acres: 39.89 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access t'public road: <br /> Proposed access to public waters to be provided YIN: �5? <br /> If yes,describe access: <br /> J g.s. <br /> Signature of Owner: ��C/t^-- //4- Date: III S/2 i <br /> Signature of Owner: Date: n <br /> o <br /> a <br /> > Does parcel meet Zoning Requirements? Yes No G /o 3/ ° <br /> N (D 7 • <br /> o > Does parcel require a Survey? Yes No <br /> °qPermit application fees submitted? 0 Amount$ t/ / <br /> Receipt# J <br /> ®Reconciles withReal Property Lister es No Date: 1119(x,, <br /> a <br /> c If not,explain: <br /> _o <br /> 1 <br /> ci. <br /> 1 <br /> Application: Approved / Denied Reason for Denial: <br /> Land Use: l 720L/ Date: <br /> --7 Nso PI ?11 Vc;")1e• re c/c74,e,5. • i <br />