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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+$50.00/lot <br /> William & Cindy Halls <br /> Owner: Buyer: A g <br /> Address:5130 191 st St W Address: o 0 <br /> Farmington MN 55024 p v, <br /> Phone: Phone: p� <br /> Original Parcel Information <br /> Tax ID#: 7849 & 7850 4' 7$u g 23 40 15 <br /> 1 Section Township Range <br /> 0 <br /> Original Description(or attach copy): Lots 55-56 Overland Add to W ] <br /> i . <br /> • <br /> I. <br /> Current Zoning: PUD Floodplain Y/N:N Wetlands Y/N: N Lake/River Class + <br /> Name of Water Body: Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N: N <br /> New Parcel Information 3 ia <br /> CScombine4existing M to lots ' <br /> Proposed New Legal Description and Parcel Size: <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) Y <br /> Proposed access to public road: C <br /> Proposed access to public waters to be provided Y/N: �C <br /> If yes,describe access: <br /> l eE <br /> Nitt*Wia . . > <br /> ➢ Does parcel meet Zoning Requirements? Yes No Fee Rec: .97.�� <br /> Check#: 6 I a 5-8' <br /> > Does parcel require a Survey? Yes No <br /> Reconciles with Real Property Lister Yes No Date: <br /> If not,explain: <br /> Applicatio pprove enied Reason for Denial? <br /> Land se: Date: <br /> „....4„....4.4.------ /' /V00 Z-5-- <br /> �14-� Sl�lowe aS ��rv,c4//c Ao e. /5 e=.1' Il V ul4 it, <br />