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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+$50.00/lot <br /> Owner: James Ross Buyer: Norma Johnson Family Living Trust <br /> b <br /> Address:210 Christopher Ave Address: 1219 30th St NW "al <br /> Waukee IA 50263 Rochester MN 55901 0 <br /> Phone: 515-210-1387 Phone: 507-881-0223 P <br /> Original Parcel Information N <br /> 07-038-2-41-14-17-5 05-006-015000 07-038-2-41-14-17-3 03-000-011000 <br /> Parcel ID#: Section 17 Township 41 N Range 14W <br /> Original Description(or attach copy): Prt Gov Lots 5&6 Lyg S of Hwy 77 &W of CTH H o <br /> Ex Hwy Desc#406004 & SW-SW <br /> t <br /> u <br /> .d Current Zoning:RR1/F1 Floodplain Y/N: N Wetlands Y/N: Y Lake/River Class: N <br /> 01 <br /> cll <br /> o Name of Water Body: N/A Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation Y/N:N Managed Forestry Law Y/N:N <br /> New Parcel Information % <br /> Proposed New Legal Description and Parcel Size: CSM changing lot lines on 2 existing parcels <br /> Acres:56.47 <br /> -;\ <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: t7 <br /> 1 <br /> Proposed access to public waters to be provided Y/N: A <br /> If yes,describe access: <br /> Signature of Owner: /UZadyL,42 . Date: 7/27/2020 <br /> N <br /> Signature of Owner: Date: c <br /> 2 <br /> > Does parcel meet Zoning Requirements? Yes No ,�i ft—�O^/7/� <br /> N Cyr— F. <br /> �+ <br /> oo > Does parcel require a Survey? Yes No <br /> �aro 2 � <br /> Permit application fees submitted? ❑ Amount$ 7�D r Receipt# <br /> U <br /> iv. ❑Reconciles with Real Property Lister Yes No Date: <br /> n. If not,explain: <br /> o <br /> o <br /> e <br /> N <br /> Application pproved / enied Reason for Denial: <br /> Land Use:914,0Date: / 6 ZO ice_ <br />