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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 w/Survey: S200.00+$50.00/lot <br /> Owner <br /> Owner: Patricia Crist $c953eX: James Crist <br /> •o <br /> ea <br /> 7610 Smetana Ln 312 Address: 5001 Chowen Ave S 3 • <br /> Address: <br /> Eden Prairie MN 55344 Minneapolis MN 55410 aA <br /> Phone: Phone: IQ <br /> N <br /> Original Parcel information <br /> 07-020-2-40-16-11-5 05-001-022000 "� <br /> Parcel ID#: 07-020-2-40-16-11-5 05-001.-021000 Section 11 Township 40N Range 16W <br /> O <br /> Original Description(or attach copy): W 200'of E 1516 1/2'of GL 1 A <br /> o <br /> Pv <br /> .fl Current Zoning: RR2 Floodplain Y/N: N Wetlands Y/N: N Lake/River Class: P^ <br /> Minnow Lake <br /> ba Name of Water Body: Shoreland Agreement/SIPS Y/N; <br /> Farmland Preservation Y/N: N Managed Forestry Law YIN: N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size:- CSYY) <br /> 1 <br /> Acres: o?.c 4 6 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> a <br /> Proposed access to public waters to be provided Y/N: ' <br /> )J <br /> If yes,describe access: <br /> P � & l <br /> Signature of Owner: X Date: �—3 D—Z 2 tN <br /> Signature of Owner: x CA.J Date: 5"'130- 1-7' o <br /> ?:5:4"."14.."'' <br /> 3 <br /> ➢ Does parcel meet Zoning Requirements? Yes - No <br /> Does parcel require a Survey? Yes No <br /> pG' <br /> 0a > Permit application fees submitted? 0 Amount$ /kt , r ' W <br /> Receipt il <br /> °4 <br /> r ® Reconciles with Real Property Lister s No Date: 1 a-1:1-a ait _ <br /> 0 <br /> a If not,explain: <br /> I -I <br /> Applicatio • v pproved / enied Reason for Denial: <br /> Land Use: Date: / 00 Z- <br />