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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: S50.00 <br /> Survey of Existing Parcel: $50.00/lot <br /> and/or Pre-Application Form Subdivision w/Survey: $200.00+550.00/lot <br /> Owner: Stone Road Farms LLC Buyer: b <br /> fD <br /> Address: 13915 Lake Drive Address: <br /> Forest Lake MN 55025 z <br /> � <br /> ,/ G <br /> Phone: 6/d •_. ' ,l - A/ ' 7 Phone: <br /> Cb <br /> Original Parcel Information <br /> Parcel ID#: 07-020-2-40-16-35-5 05-004-011200 Section 35 Townshi 40 Range 16 <br /> O <br /> Original Description(or attach copy): Lot 3 CSM V26 P 231-233 GL 4 a <br /> OD <br /> _IP- <br /> .o Current Zoning: A2/RR2 Floodplain YIN: Y Wetlands Y/N: Y Lake/River Class: <br /> la <br /> fl'c Name of Water Body: Connors Lake Shoreland Agreement/SIPS YIN; <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N: N <br /> New Parcel Information <br /> i-) <br /> Proposed New Legal Description and Parcel Size: 2 Lot CSM <br /> Acres: N <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) (- <br /> Proposed access to public road: C <br /> to <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: E <br /> Signature of Owner: „WY ,d _.21-ext. ea„.1 �G.r y>Date: 7 '-2/-o2C 92 <br /> l <br /> Signature of Owner: Date: on <br /> B <br /> D Does parcel meet Zoning Requirements? Yes No Cl/ . -a 4056 a' C <br /> A <br /> t <br /> p ➢ Does parcel require a Survey? Yes No <br /> E. p0 Gl <br /> Q° ➢ Permit application fees submitted? 0 Amount$ 30a- — Receipt# <br /> r.., 0 Reconciles with Real Property Lister Yes No Date: <br /> m <br /> a <br /> a If not,explain: <br /> A <br /> 0 <br /> a <br /> Applicatio pprove / Denied Reason for Denial: <br /> Land Use: ' _ _ Date: 7 ge Z . <br />