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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+$50.00/lot <br /> Owner: Everhome Properties LLC Buyer: b <br /> Address:7261 Mill Rd Address: B <br /> Centerville MN 55038 p <br /> 0 <br /> U1 <br /> C. <br /> Phone: Phone: nli <br /> t <br /> Original Parcel Information <br /> Parcel ID#: 07-032-2-41-16-13-5 15-044-020001 Section 13 Township 1 N Range 16W <br /> 16.1 <br /> Original Description(or attach copy): Bass Lake Assessors Plat Lot 10 Ex CSM V25 P258a <br /> CDn <br /> 00 <br /> .o Current Zoning: RR2 Floodplain Y/N: Y Wetlands Y/N: Y Lake/River Class: 0 <br /> ,.d p O <br /> a Name of Water Body: Bass Lake Shoreland Agreement/SIPS Y/N: <br /> a <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N:N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: 2 CSM 6 lots L <br /> le <br /> Acres: 16.95 f <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: C7 <br /> a <br /> n <br /> Proposed access to public waters to be provided Y/N: lr <br /> If yes,describe access: tr- <br /> Signature of Owner: / )2 4 I 0./--4-‘9')1.- Date: 5-20-21 QV <br /> Signature of Owner: ,7U Nuiv.:0 Date: 5-20-21 c <br /> B <br /> > Does parcel meet Zoning Requirements? Yes No de,0 600 3 9 7 / ,5 <br /> T�a ➢ Does parcel require a Survey? Yes No 0 e- !M <br /> a 04 <br /> O0 <br /> I" > Permit application fees submitted? 0 Amount$ '7&9I � Receipt# W <br /> 0 <br /> d ®Reconciles with Real Property Lister ED No Date: 6/1/&X <br /> a <br /> R• If not,explain: <br /> m <br /> o <br /> 0 <br /> R. <br /> y <br /> - <br /> Application: •pproved / Denied Reason for Denial: <br /> Land Use:w�1.Ac--- 6 2l Z'0--/ Date: <br />