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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+$50.00/lot <br /> Owner: Janice Carver Buyer: .ti <br /> eD <br /> Address: 2753 Gerald Ave Address: g. <br /> N St Paul MN 55109 z <br /> oc./1 <br /> C <br /> 05 <br /> Phone: Phone: t <br /> Original Parcel Information <br /> Parcel ID#: 07-028-2-40-14-20-5 15-545-050000 Section 20 Township 40 Range 14 Q1 <br /> 0 <br /> Original Description(or attach copy): Oak Lake Addition#1 a <br /> 0 <br /> n <br /> L— <br /> §*) <br /> .a Current Zoning: RR2 Floodplain V/N: Y Wetlands V/N: N Lake/River Class: (� <br /> 'a (b <br /> a Name of Water Body: Oak Lake Shoreland Agreement/SIPS V/N: <br /> a <br /> ic..: <br /> Farmland Preservation YIN: N Managed Forestry Law YIN: N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: CSM (44 <br /> Acres: 0.76 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: C <br /> a <br /> R <br /> Proposed access to public waters to be provided V/N: <br /> If yes,describe access: NI <br /> Signature of Owner: to;40 irAtukt, Date: 12.6.22 <br /> NN <br /> Signature of Owner: Date: 'a <br /> 3 <br /> v <br /> parcelZoning Requirements? 6070� i9 <br /> ➢ Does meet Yes No <br /> a ➢ Does parcel require a Survey? Yes No <br /> a <br /> 5 .00 ..) <br /> °Q ➢ Permit application fees submitted? ❑ Amount$ �/ Receipt# <br /> r. ® Reconciles with Real Property Lister es No Date: 1'L-9- a a <br /> a <br /> .M_ <br /> a <br /> aIf not,explain: <br /> n <br /> a NI <br /> Application• pproved / Denied Reason for Denial: <br /> Land Use: Date: /WW2-2— <br />