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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+$50.00/lot <br /> Owner: Robert Emer Buyer: <br /> i;••? <br /> Address:3020 Rice St TrIr 89 Address: i <br /> Little Canada MN 55113 p <br /> Phone: Phone: G <br /> Original Parcel Information kT <br /> Parcel ID#: 07-018-2-39-16-33-5 15-462-018000 Section 33 Township 39N Range 16W L <br /> 1 <br /> g Description mal Descri tion(or attach copy): Mar-Lee Acres Lot 8 <br /> e, <br /> .d Current Zoning: RR1 Floodplain Y/N: N Wetlands Y/N: N Lake/River Class: <br /> b <br /> cN/A <br /> o Name of Water Body: Shoreland Agreement/SIPS Y/N: fit <br /> T Farmland Preservation Y/N:N Managed Forestry Law Y/N:N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: CSM 2 lot divide <br /> Acres:2.5 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: Z <br /> m <br /> fiL <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: <br /> Signature of Owner: f • <br /> ../.. Date: r, . (...,c a i ,.. <br /> N <br /> Signature of Owner: Date: o <br /> ➢ Does parcel meet Zoning Requirements? Yes No l.4.. 6o.5-�2.___ F. <br /> FP <br /> c > Does parcel require a Survey? Yes No <br /> E. q� <br /> D N <br /> 00 ➢ Permit application fees submitted? ❑ Amount$ 300• Receipt# <br /> r., 0 Reconciles with Real Property Lister Yes No Date: <br /> a� <br /> a. If not,explain: <br /> o <br /> 0 <br /> R. <br /> Applicatio 1• • pproved enied Reason for Denial: <br /> Land Use: ��...r . 2-//e W Z 2—Date: <br />