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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+$50.00/lot <br /> Owner: Thomas Chaklos Buyer: e . <br /> et <br /> Address: 3161 140th St NW Address: <br /> Prior Lake MN 55372 0i. <br /> 612-281-9055 Phone: Phone: <br /> Original Parcel Information i <br /> 07-012-2-40-15-10-5 15-128-318000 <br /> Parcel ID#: 319000. 320000. 321000 Section 10 Township 40N Range 15W <br /> O <br /> Original Description(or attach copy): Deerpath Add to VV Lots 309-312 <br /> ep <br /> 3 <br /> .0 Current Zoning: PUD Floodplain Y/N: N Wetlands Y/N: N Lake/River Class: U <br /> so Name of Water Body: Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N: <br /> N <br /> New Parcel Information G <br /> lA <br /> Proposed New Legal Description and Parcel Size: <br /> CSM combine lots <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: C7 <br /> f9 <br /> Proposed access to public waters to be provided Y/N: <br /> �\N <br /> If yes,describe access: <br /> ma ���, V— 9/8/22 N <br /> Signature of Owner: Date: c <br /> 3 <br /> C <br /> ➢ Does parcel meet Zoning Requirements? Yes No A-‘0 7o X eo <br /> o ➢ Does parcel require a Survey? Yes No <br /> °Q ,- Permit application fees submitted? ❑ Amount$ ,572, Receipt# <br /> t M Reconciles with Real Property Lister es No Date: It-q- 22 p <br /> 0 <br /> a If not,explain: '�l <br /> 7J an <br /> A <br /> o <br /> Q \ <br /> No <br /> Application: Approved / enied Reason for Denial: <br /> Land Use: <br /> /L//�%Z Z—Date: <br /> 5.Z.4,,.....?:..A--44.------) <br />