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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+$50.00/lot <br /> Owl.cr: Je �;Kyle Buyer: b <br /> et <br /> Address: 3525 Pine Hollow Place Address: B <br /> 2 <br /> Stillwater MN 55082 - <br /> CP <br /> Phone: Phone: <br /> Original Parcel Information <br /> Parcel ID#: 07-030-2-38-16-15-5 05-003-017000 Section 15 Township 38N Range 16W <br /> O <br /> Original Description(or attach copy): GL 2 & 3 <br /> eD <br /> -t <br /> -a Current Zoning: RR! ��I odplain YIN: Y Wetlands Y/N: Y Lake/River Class: <br /> Name of Water Body: Clam Lake Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N: N N. <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: SM <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: p <br /> w <br /> T <br /> Proposed access to public waters to be provided Y/N: <br /> If yes, describe access: <br /> Vt. i <br /> Signature of Owner: c. l Date: (1 (02.1/ c710c, I 0j <br /> 111 /v <br /> Signature of Owner: Date: 1 (al f aJ I o <br /> parcelg ! Cj a6o 5 Z o <br /> Does meet Zoning Requirements. Yes No <br /> z <br /> NI <br /> > Does parcel require a Survey? Yes No <br /> °p V)Permit application fees submitted? 0 Amount$ 3© / Receipt# '-'• <br /> r. ® Reconciles with Real Property Lister CD No Date: 4-10-2.2 <br /> s: <br /> 0 <br /> °' If riot,explain <br /> T – - — - t <br /> ez <br /> r: <br /> o <br /> z <br /> a. <br /> Applicatio . Approved / )enied Reason for Denial: - 0 <br /> Land use: GJ' v <br /> � e eDate: <br />