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✓Vt,1.1)1y1 I CI IVelLye I . IOJ IIli/•%-y I✓D-4✓GO-OI OJ-C II-OV`FVL/ IJL <br /> Burnett County Subdivision Permit Application Fees(must accompany form): <br /> . and/or Pre-Application Form or MapReview Form Subdivision w o Survey: 550.00 <br /> • pp Survey of Existing Parcel: 550.00/lot <br /> Subdivision w Survey: 5200.00+550.00/lot <br /> Owner: BRIAN & STACY HAUGEN Buyer: <br /> 14050 490TH ST , <br /> Address: PINE ISLAND MN 55963 Address: <br /> e <br /> vi <br /> 507-208-0791 <br /> Phone: Phone: <br /> 1 <br /> Original Parcel Information <br /> Parcel ID#:028412602300&07-028-2-40-14-26-5 05-0 3001 Section 26 Township 40 Range 14 <br /> SW'/4-NE% andpart of Gov. Lot 1 as described in <br /> Original Description(or attach copy): .. <br /> Document No. 464611 . 33, <br /> f' <br /> RR-3 <br /> Current Zoning: Floodplain Y/N: N Wetlands Y/N: Y Lake/River Class: <br /> .a Name of Water Body: Unnamed Lake called Haugen LakeShoreland Agreement/SIPS YIN: 'v <br /> la <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N: N <br /> E 1 <br /> 1 <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: 12 lots created by County Plat using the <br /> provisions of Density Development. See attached plan. <br /> Acres: 63.2 Acres <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: Direct access to County Highways with easements as shown v <br /> Proposed access to public waters to be provided Y/N: N <br /> If yes,describe access: 1;,_ <br /> , 0..,,c.f34—d br. <br /> Signature of Owner: �,¢, ` o nea by: 11/22/2021 <br /> Date: n <br /> signature of owner: nate: 11/22/2021 © <br /> N.-4Au1btabb44a41A... _-- 'C <br /> a <br /> ➢ Does parcel meet Zoning Requirements? Yes No ED ft <br /> -I <br /> > Does parcel require a Survey? Yes No [IECEOW <br /> L--K 0Q/241 UJ <br /> 5 Permit application fees submitted? 0 Amount$ .8af li 2021 V <br /> ReN V# <br /> 0 Reconciles with Real Property Lister Yes No Date: - 4 <br /> Burnett County ,../`l� <br /> Land Services Department <br /> A, If not,explain: <br /> a p� <br /> o 'lin <br /> c, Applicatio Approve/ Denied Reason for Denial: <br /> Land Use: ► , , ab iroa4 6144siIyee Date: <br /> e9/4 /Z 7 2oZf, �/�-� i /9 ZGZ/ <br />