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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision who survey $50.00 <br /> Survey of Existing Parcel: $50.00/lot <br /> and/or Pre-Application Form or Map Review Form Subdivision w/Survey $200.00+$50.00/lot <br /> C A <br /> owner: Erickson Commercial LLC Buyer: Grecia Jimenez v i <br /> Address: <br /> PO Box 614 Address: 14750 W Burnsville Pkwy#252 1 o <br /> Webster WI 54893 Burnsville MN 55306 1 <br /> N <br /> W <br /> Phone: Phone: <br /> Original Parcel Information <br /> 07-018-2-39-16-28-2 03-000-011100 section 28 _Township 39N R9nge 16W <br /> Tax ID#: p <br /> 07-018-2-39-16-28-2 03-000-011200 <br /> Original Description(or attach copy): <br /> CSM V30 P107-1 08&SW-NW <br /> i <br /> Current Zoning: C1/RR3 Tloodplain Y/N:N Wetlands Y/N:N Lake/River Class: N. <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 1 G <br /> Proposed New Legal Description and Parcel Size: CSM f � <br /> N <br /> e <br /> Acres. <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: e <br /> Proposed access to public waters to be provided Y/N: .. <br /> If yes,describe access: - <br /> 1 <br /> Signature of Owner: (7rPCI:a T Date: 10/31/23 0 0 <br /> Signature of Owner - Date: Id 1 V 2j <br /> Fee Rec: �,�� <br /> ➢ Does parcel meet Zoning Requirements? Yes No 61 Check#:h O s op. <br /> P <br /> ➢ Does parcel require a Survey? Yes No e1 <br /> w <br /> Reconciles with Real Property Lister 0 No Date: 11l t l+20 23 S <br /> If not,explain: i <br /> Application %.proved 0 nied Reason for Denial= <br /> Land Date: <br /> // / 3 <br />