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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: S50.001lot <br /> and/or Pre-Application Form Subdivision ivt Survey: S200.00+S50.00/lot <br /> Owner: John Sylvestre Buyer: ,ti <br /> Address: 5246 14th Ave S Address: <br /> 3 <br /> Minneapolis MN 55417 c <br /> C:a <br /> 612-720-7269 G <br /> Phone: Phone: <br /> Orisinal Parcel Information <br /> 07-032-2-41-15-29-1 01-000-015000 <br /> Parcel ID#:.07-032-2-41-15-29-1 01-000-014000 Section 29 Township 41N Range 15W <br /> 07-032-2-41-15-29-1 01-000-0130000tet <br /> Original Description(or attach copy): g <br /> NE-NE <br /> a Current Zoning: RR3 Floodplain Y/N: Y Wetlands YIN: N Lake/River Class: 3 <br /> .Q <br /> to Name of Water Body: Stone Lake Shoreland Agreement/SIPS Y/N <br /> r. Farmland Preservation Y/N: N Managed Forestry Law Y/N: N R <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: G <br /> m <br /> Proposed access to public waters prbeTtrovided Y/N: 1' <br /> If yes,describe access: <br /> 'Vj <br /> Signature of Owner: Date:-12. E i I N <br /> Signature of Owner: Date: n <br /> 3 <br /> 'a <br /> ➢ Does parcel rneet Zoning Requirements? Yes No <br /> 19 <br /> Does parcel require a Survey? Yes No <br /> a <br /> 00 ➢ Permit application fees submitted? 0 Amount Z Receipt# Q' <br /> all <br /> r, NI Reconciles with Real Property Lister () No Date: C- 8‘- a a . <br /> °' If not,explain: <br /> n ,3 <br /> O <br /> h <br /> Application:l'.- prove. ,Denied Reason for Denial: <br /> pp.4 <br /> • <br /> Land Use:/ /�'�c--- // 7- Z Date: <br />