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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision wio Spey: $su ea <br /> Survey of FYisring Passel: $SftsltMot <br /> and/or Pre-Application Form or Map Review Form subdivision wlSurvey S20 00+s50.QUliot <br /> II <br /> owner: Alice S Sheller Trust Kelly Mackereth el <br /> ti <br /> Address 4101 Zenith Ave S Address• 715 SW 51st Terrace go <br /> m o <br /> • .. <br /> Minneapolis MN 55410 Cape Coral FL 33914 <br /> Phone: Phone: <br /> Original Parcel Information <br /> 07-012-2-40-15-25-5 05-001-014000&015000 25 40N 15W I <br /> Tax ID#: Section Township Range <br /> Original Description(or attach copy): Lot 1 &2 CSM V 1 P242 GL 1 <br /> c <br /> 1 <br /> Current Zoning: RRI Fioodpiain Y/N: Y Wetlands Y/N: Y Lake/River Claw <br /> Name of Water Body: Sand Lake/Pine Lake Shorelaad Agreement/SIPS YIN: <br /> Farmland Preservation YIN: N Managed Forestry Law YIN: N <br /> I <br /> New Parcel Inforotation <br /> Proposed New Legal Description and Parcel Size: <br /> I Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements) <br /> Proposed access to public road: <br /> G Proposed access to public waters to be provided YIN: It <br /> If yes,describe access: <br /> fe2, "P,Z 2'23 <br /> ,ate :... <br /> ➢ Does meet Zoning Fee Rev: <br /> F� rung Requirements? Yes No _ <br /> Check <br /> > fops parcel require a Survey? Yes No <br /> 1 <br /> A <br /> Reconciles with Real Property Lister Yes No Date: <br /> If not,explain: <br /> 4 <br /> Application: Approved f Denied Reason for Denial- <br /> Land Use: Date: <br /> t <br />