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Fees(must accompany form): <br /> P Y <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+$50.00/lot <br /> Owner: Richard Stoffels Trust Owner Mark &Tamara Bratland <br /> eo <br /> Address: 10664 Water Lilly Ln Address: 4675 Yorktown Ln i. <br /> Woodbury MN 55129 Plymouth MN 55442 <br /> 0 <br /> Phone: Phone: <br /> Original Parcel Information <br /> ? <br /> Parcel m#: 07-020-2-40-16-35-5 05-007-016000&017000 Section 35 Township 40N Range 16W <br /> cO <br /> G <br /> Lot 4 & 5 CSM V16 P2267 <br /> Original Description(or attach copy): o <br /> eo <br /> el- Vt5 'mag <br /> 1 ,1 <br /> .n Current Zoning: RR1 Floodplain Y/N: Y Wetlands Y/N: N Lake/River Class: <br /> .c <br /> «or i <br /> to Name of Water Body:• Devils Lake Shoreland Agreement/SIPS Y/N; _ <br /> Farmland Preservation YIN:N Managed Forestry Law Y/N:N \ <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: CSM Change existing lot lines ' <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> Do <br /> et <br /> Proposed access to public waters to be provided Y/N: -- <br /> If yes,describe access: _ <br /> Signature of Owner:__L�� Date: 9‘ 1 5-4)a) t <br /> if \ ' <br /> n <br /> Signature of Owner: / ��►� ��� ��' _ �� Date: o <br /> l <br /> N <br /> > Does parcel meet Zo g Requirements? es No de-- <br /> /O C <br /> o > Does parcel require a Survey? Yes No (Q T C� <br /> °° ➢ Permit application fees submitted? 0 Amount$ �oO/ Receipt# 0 <br /> G <br /> ®Reconciles with Real Property Lister Yes No Date: 1n .,/(L),l <br /> m <br /> a <br /> a. If not,explain: t� <br /> A8 <br /> 0 <br /> C. <br /> Application: pproved nied Reason for Denial: <br /> Land Use: / Zi'z/ Date: <br /> / / <br /> 1 <br />