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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 /> ca <br /> b <br /> col eD <br /> Owner: Johnson Lake Pines LLC x : John Willard g <br /> O '* <br /> Address:38868 12th Ave Apt 26 Address: 38868 12th Ave Apt 26 '4 c <br /> North Branch MN 55056 North Branch MN 55056 -N cti <br /> N <br /> Phone: Phone: <br /> Original Parcel InformationV. <br /> Tax ID#: 07-020-2-40-16-14-5 05-001-015000 Section 14 Township 40 Range 16 G <br /> 07-020-2-40-16-14-5 05-001-014000 <br /> Original Description(or attach copy): Lt 4& 5 CSM V7 P201 GL1 <br /> 3G <br /> Current Zoning: RR1 Floodplain Y/N:Y Wetlands Y/N: Y Lake/River Class. r <br /> Shoreland Lake 'I <br /> Name of Water Body: oreland Agreement/SIPS Y/N: � <br /> r-- <br /> Farmland Preservation Y/N:N Managed Forestry Law Y/N: N <br /> R, ilk <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: 2 Lot CSM of existing parcels <br /> I <br /> Acres- <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: c <br /> Proposed access to public waters to be provided Y/N: <br /> 04 <br /> 03 <br /> If yes,describe access: <br /> O <br /> . iek <br /> Gv�E , ,r: 8/12/24 <br /> ➢ Does parcel meet Zoning Requirements? Yes No Fee Rec: /O4. Q0/ <br /> Check#: 6/03/ <br /> ➢ Does parcel require a Survey? Yes No <br /> Reconciles with Real Property Lister Yes No Date: <br /> If not,explain: <br /> Application: Approved / D_ 'ed Reason for Denial. <br /> Land U : Date: <br /> b zo Z`' <br />