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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/Survev: $200.00+$50.00/lot <br /> Owner: Timothy D.Stelter/Thomas Nelson Buyer: Kelly Orth �\ <br /> Address:_ 280 Woodridge Drive Address: 15621 Highview Drive <br /> Vadnais Heights,MN 55127 Apple Valley,MN 55124 L <br /> Phone: 651-261-7447 Phone: 952-201-1161 O <br /> F <br /> 0 <br /> Orieinal Parcel Information <br /> Parcel ID#: 07-032-2-41-16-13-5-15-044-020000 Section 13 Township 41N Range 16W <br /> Original Description(or attach copy): Bass Lake Assessors Plat Lot 10 <br /> 30932 Tower head <br /> tr � <br /> Current Zoning: RR2 Floodplain Y/N: N Wetlands Y/N: Y Lake/River Class: <br /> D Name of Water Body: Rays Lake Shoreland Agreement/SIPS Y/N- <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N: N <br /> m <br /> 0 <br /> .. New Parcel Information Q <br /> Proposed New Legal Description and Parcel Size: TBD (ISM ��� .A5 <br /> d <br /> Acres: 1.5 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) >` <br /> Proposed access to public road: Tower Road <br /> Proposed access to public waters to be provided Y/N: Y <br /> If yes,describe access: Approximately 200 linear feet of lakeshore on Bass Lake <br /> Signature of Owner: Date: <br /> Signature of Owner: CVKf Date: <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> N ➢ Does parcel require a Survey? Yes No <br /> e <br /> 5 ➢ Permit application fees submitted? Amount$ Receipt# <br /> Reconciles with Real Property Lister Yes No Date: <br /> r <br /> m If not,explain: <br /> e <br /> a <br /> n <br /> 0 <br /> a Applicatio Approved / enied Reason for Denial: <br /> H <br /> Land Use: <br /> OCT 2 S 2015 <br /> BURNETT COUNTY <br />