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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey $50.00 <br /> and/Or Pre-A IlCatiOn Form Survey of Existing Parcel: S50.00/lot <br /> PP Subdivision w/Survcv_ S200.00+$50.00/lot <br /> Owner: Robert Dreis Buyer: <br /> •o <br /> Address6348 Edgewood Ave Address: . <br /> Woodbury MN 55125 z <br /> oa <br /> Phone: Phone: Z <br /> Original Parcel Information . <br /> 07-018-2 39-16-35 5 05-004-030000 <br /> Parcel ID#: 07-018-2 39-16-35-5 05-004-031000 Section 35 Township 39N Range 16W V <br /> 51 <br /> Original Description(or attach copy): GL 4 Lot 11 & 12 <br /> o <br /> n <br /> Current Zoning: RR1 FIoodpiain Y/N: Y Wetlands Y/N: Y Lake/River Class: I <br /> • <br /> s Name of Water Body: Lower Clam Lake Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N N 'F <br /> U' <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: C <br /> lz <br /> Proposed access to public waters to be provided Y/N: lt <br /> If yes,describe access: <br /> Signature of Owner: a.. Date: . /'.".2A <br /> Signature of Owner: Date: o' <br /> 3 <br /> •a <br /> D. Does parcel meet Zoning Requirements? Yes No 4_0A <br /> N <br /> > Does parcel require a Survey? Yes No <br /> ° O <br /> ea )- Permit application fees submitted? 0 Amount$ 529 ' Recei t# <br /> P � <br /> 6-- <br /> m ®Reconciles with Real Property Lister No Date: IO - lq -a a <br /> 0- If not,explain: <br /> o <br /> o <br /> N <br /> .:us <br /> ou <br /> - <br /> 6' <br /> Applicatio.• pprov , ')exiled Reason for Denial: <br /> Land Use:. .1. /d ZO Z Date: <br />