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Burnett County Subdivision Permit Application <br /> Fees(must accompany form): <br /> and/or Pre-Application FormMapReview Form Subdivision w o Survey: S50.00 <br /> l�l� on or Survey of Existing Parcel: S50.00/lot <br /> Subdivision w Survey: S200.00+S50.00/lot <br /> Owner: KATHERINE ROMEISER Buyer: Mark Gibbs .9 <br /> tD <br /> 7913 CENTRAL AVE NE 3 <br /> Address: SPRING I AKF PARK MN 55432 Address: �* <br /> a <br /> ta <br /> Phone: 651 276 084." Phone: <br /> Original Parcel Information 1 <br /> Parcel ID#: 024310901200 Section 9 Township 39 Range 14 O <br /> 4 <br /> a <br /> ro <br /> Original Description(or attach copy): Gov <br /> T c. ieZ,' /.570S <br /> k--- <br /> RR-3 4k(e <br /> N/A , <br /> Current Zoning: Floodplain Y/N: JWetlands Y/N: Y Lake/River Class: <br /> Benoit Lake / <br /> .a Name of Water Body: Shoreland Agreement/SIPS Y/N: N <br /> z <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N:so <br /> N <br /> E. New Parcel Informationti <br /> Proposed New Legal Description and Parcel Size: The West 580 feet of Government Lot 2. erN <br /> Pi <br /> Acres: 15.8 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> Direct access to CTH H. ° <br /> Proposed access to public waters to be provided Y/N: This parcel fronts on Benoit Lake <br /> If yes,describe access: <br /> NI <br /> Signature of Owner: N/A Date: \M <br /> signature of owner: uate: 3 <br /> c <br /> > Does parcel meet Zoning Requirements? Yes No Wet.uvedea seolnaag puei <br /> Aiunoc;lawng <br /> N ➢ Does parcel require a Survey? Yes No �- - <br /> E. EZK➢ Permit application fees submitted? 0 Amount S TO i eceipt V f7 <br /> la 3 a (_ t <br /> ❑ Reconciles with Real Property Lister4E30 No Date n �/ 3�� <br /> UU 6/ <br /> aIf not,explain: <br /> a <br /> n <br /> a <br /> Q Application Ap roved c ni eason for Denial: / <br /> Land Use: Date: /f/6/2Q Z 3 <br /> Coi4 H/14k/47 DeP 71/44'GM a l- c/a�Nuew7 QcceSS 710 C747 /mod /7, <br />