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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o SLrvey: $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 /> Paul Gorski <br /> Owner: Buyer: ,b <br /> co <br /> 13701 Duluth Dr <br /> Address: Address: <br /> M <br /> Apple Valley MN 55124 z <br /> a <br /> c <br /> Phone: Phone: <br /> N <br /> Original Parcel Information \N <br /> 1 <br /> Parcel ID#: 07-020-2-40-16-19-5 15-360-085000 Section 19 Township 40N Range 16W <br /> Original Description(or attach copy): Jensen's Lakeshore Div of Yellow Lake Lts 21 &22 Blk 10 4 <br /> 1J <br /> bCurrent Zoning: RR1 Floodplain Y/N: �' Wetlands Y/N: N Lake/River Class: <br /> n Yellow Lake <br /> Name of Water Body: Shoreland Agreement/SIPS Y/N: <br /> aq.'4 <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N: N <br /> 6. <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: CSM combine existing 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: 0 <br /> a <br /> Proposed access to public waters to b ovided Y/N: e°..0 <br /> If yes,describe <br /> $ "e�I` i�'�°_ Date 1/7 Z Z <br /> �1J <br /> Signature of Owner: Date: n <br /> 0 <br /> b <br /> > Does parcel meet Zoning Requirements? Yes No <br /> ro <br /> 0 > Does parcel require a Survey? Yes No <br /> w <br /> °rc' > Permit application fees submitted? ❑ Amount$ 99I r Receipt# <br /> El Reconciles with Real Property Lister es No Date: ctx.1 <br /> °' If not,explain: <br /> M <br /> n <br /> a <br /> Application. pproved / D:i•ed Reason for Denial: <br /> Land Use -- ! 74Z 3 Date: <br />