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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: S50.00/lot <br /> and/or Pre-Application Form Subdivision Iv/Survey: S200.00+S50.00/lot <br /> 1----1 Owner: Scott Teskey _ Buyer: Leslie Vvatson- Birch Island LLC <br /> rA <br /> Address: 5636 15th Ave S Address: 3504 Architect Ave <br /> z <br /> Minneapolis MN 55417 Minneapolis MN 55418 0 <br /> Phone: Phone: ("� <br /> Original Parcel Information ] <br /> 07-028-2-40-14-19-5 05-004-011000 <br /> Parcel ID#:07-028-2-40-14-18-.5 05-008-018000 <br /> Section <br /> l8& 19 Township 40N Range 14W <br /> Original Description(or attach copy): S19 GL 4, S18 GL8 <br /> Current Zoning: BR2 Floodplain Y;N: Y Wetlands YIN: Y Lake/River Class:__ <br /> ; Name of Water Body: Birch Island Lake Shoreland Agreement/SIPS Y/N; - \ <br /> .. Farmland Preservation YIN: N Managed Forestry Law YIN: N tk- <br /> New Parcel Information <br /> - ?4-::..vcpcse ?4-::..v.'L <br /> v ^g,.Description an,i Prrc'l'.;-7.: CSM to change existing lot lines <br /> ( -._—�— -- Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Pr'F-osed access to puh':ic road: <br /> Proposed access to public waters to be provided '/N: 114 <br /> If yes,describe access: <br /> � <br /> , <br /> Signature of Owner: _ /, /. �L�� Date: he/c72,/Z/ N <br /> Signature of Owner: _-‹ d-ei ,,<.,�e.�, -4" Date: /1/7/ 2„7L/ o <br /> / <br /> > Does parcel meet Zoning Requirements? Yes No e 6Q,S399 m <br /> 9 <br /> 0 > Does parcel require a Survey? Yes No <br /> Dom- W <br /> Permit application fees submitted? 0 Amount$ /4©� Receipt# <br /> r, ® Reconciles with Real Property Lister Yes No Date: to-Ito - (a) <br /> m1 <br /> a' ii not,explain: - <br /> n <br /> c <br /> E..-: Q <br /> AppIicatio I Approved Denied Reason for Denial: <br /> Land Use: `-/ 7�'&'Z Z.Date: - <br />