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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+$50.00/lot <br /> Owner: James Ross Buyer: Norma Johnson Family Living Trust <br /> 1219 30th St NW <br /> Address:210 Christopher Ave a <br /> Address: <br /> Waukee IA 50263 Rochester MN 55901 <br /> Phone: 515-210-1387 Phone: 507-881-0223 <br /> Original Parcel Information <br /> 07-038-2-41-14-17-5 05-006-015000 07-038-2-41-14-17-3 03-000-011000 <br /> Parcel ID#: Section 17 Township 41 N Range 14W <br /> Original Description(or attach copy): Prt Gov Lots 5 &6 Lyg S of Hwy 77&W of CTH H <br /> to <br /> Ex Hwy Desc#406004 &SW-SW =• <br /> Current Zoning:RR1/F1 Floodplain Y/N: N Wetlands Y/N:Y Lake/River Class: <br /> Name of Water Body: N/A Shoreland Agreement/SIPS Y/N; <br /> Farmland Preservation Y/N:N Managed Forestry Law Y/N:N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: CSM changing lot lines on 2 existing parcels <br /> Acres:56.47 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> a <br /> Proposed access to public waters to be provided Y/N: e� <br /> If yes,describe access: <br /> Signature of Owner: agerrmed d:.c 4.1 Date: 1-a a.2" <br /> Signature of Owner: S,1411/°g _ C d/ Date: y-....2..7-a?.0,2D <br /> > Does parcel meet Zoning Requirements? Yes No g <br /> ➢ Does parcel require a Survey? Yes No <br /> d0 ➢ Permit application fees submitted? 0 Amount$ Receipt# <br /> 0 Reconciles with Real Property Lister Yes No Date: <br /> a <br /> If not,explain: <br /> 0 <br /> Application: Approved / Denied Reason for Denial: <br /> Land Use: Date: <br />