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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+$50.00/lot <br /> Owner: Steven & Sandra Pearson Buyer: Dan Waldhauser „o <br /> A <br /> ^S <br /> Address: 5317 Beard Ave Address: 8590 W Bass Lake Road 3 <br /> z <br /> Minneapolis, MN 55410 Danbury, WI 54830 P <br /> c <br /> Phone: 612-709-3733 Phone: 715-733-0012 0' <br /> a <br /> Original Parcel Information <br /> Tax ID: 24190 PIN: 07-036-2-40-17-14-5 05-003-042000 <br /> Parcel ID#: Tax ID: 24789 PIN: 07-036-2-40-17-14-5 05-003-043000 Section 14 Township 40 Range 17 <br /> sr' <br /> Original Description(or attach copy): Port of Gov't Lot 3 a <br /> as described in Doc.# 446585 and 459872 "th <br /> .c c <br /> 4' <br /> ▪ • <br /> 3 Current Zoning: RR1 Floodplain Y/N: Wetlands Y/N: <br /> Lake/River Classification: Name of Water Body: Bass Lake P <br /> Shoreland Agreemt or SIPS Y/N: Farmland Preservation YIN: Managed Forestry Law Y/N: T <br /> New Parcel Information <br /> t4 f <br /> Proposed New Legal Description and Parcel Size: Proposed CSM <br /> (No new lots — Prepared to facilitate agreement between adjacent owners regarding existing driveway) <br /> 3 <br /> Acres: 1.28ac <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: West Bass Lake Road p <br /> X <br /> Proposed access to public waters to be provided Y/N: ;o <br /> �\ <br /> If yes.describe access: <br /> Signature of Owner: / Date: ( (q.S"124 <br /> Signature of Owner: i60/n (,Q Date: /1ll6/.2./ o <br /> 9 <br /> D Does parcel meet Zoning Requirements? Yes No4., 278 ek eta a <br /> ID Does parcel require a Survey? Yes No <br /> �� <br /> > Permit application fees submitted? 0 Amount$ l©© • Receipt# <br /> , <br /> ,43 <br /> m l�Reconciles with Real Property Lister es No Date: la-V1-a( <br /> isa <br /> ?o If not,explain: <br /> n <br /> o �t <br /> G <br /> Applicatioved / t enied Reason for Denial: <br /> ;;2:0,,_____N"" /OA 7 ZOO <br /> Land Use: Date: <br />