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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 or Map Review Form Subdivision w/Survey: $200.00+$50.00/lot <br /> Il b <br /> CA <br /> Garry & Carole Loufek <br /> Owner: Buyer: tv 2 <br /> Address:2035 Wellesley Ave Address: a <br /> St Paul MN 55105 X <br /> 0 N <br /> Phone: Phone: • '' <br /> Orieinal Parcel Information J°, kyk <br /> riS <br /> Tax ID#: 07-02R-7-40-14-07-5 15-f153-1)71non Section 07 Township 40 Range 14 C <br /> 07-028-2-40-14-07-5 15-853-022000 Lts 11-12 Wood Green Add to W <br /> Original Description(or attach copy): <br /> g co <br /> n <br /> vn <br /> l► <br /> Current Zoning: PUD Floodplain Y/N:N Wetlands Y/N: N Lake/River Class- <br /> 4: <br /> Name of Water Body: Shoreland Agreement/SIPS Y/N: 9 <br /> w <br /> Farmland Preservation YIN:N Managed Forestry Law YIN: N rli+ <br /> New Parcel Information 0 <br /> Proposed New Legal Description and Parcel Size: CSM to combine 2 existing lots g <br /> y <br /> Acres* <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) k <br /> Proposed access to public road: 5 <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: .D "C <br /> f ,410 <br /> Signature of Owner: Date:_� Z N <br /> Signature of Owner: Date: <br /> SO2 <br /> Fee Rec: .90 <br /> ➢ Does parcel meet Zoning Requirements? Yes No Check#: Co/D 5/3 <br /> ➢ Does parcel require a Survey? Yes No <br /> Reconciles with Real Property Lister Yes No Date: <br /> If not,explain: <br /> Application: proved / nied Reason for Denial. <br /> Land Us •• l-D q Date: <br />