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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 Subdivision w/Survev: $200.00+x50.00/lot <br /> Owner: Brett Johnson Buyer: <br /> b <br /> Address: 2676 240th Ave. Address: 3 <br /> Brook Park, MN 55007 z <br /> 320-244-5217 <br /> Phone: Phone: <br /> Orieinal Parcel Information <br /> Parcel ID#: 032533305700 Section 33 Township 41 N Range 16W <br /> Original Description(or attach copy): Attached <br /> A <br /> b Current Zoning: RR2 Y YFloodplain Y/N: Wetlands Y/N: Lake/River Class: NA <br /> Name of Water Body: Round Lake Shoreland Agreement/SIPS YIN: N Cj <br /> - S <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N: N <br /> New Parceel�Informationn r �R <br /> Proposed New Legal Description and Parcel Size:(��,rn �/ �i") 30,I �� J <br /> Lot 1 of Certified Survey Map <br /> Acres: 0.93 acre <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: Existing Round Lake Drive p <br /> w <br /> Proposed access to public waters to be provided Y/N: N <br /> If yes, describe access: I <br /> Signature of Owner: Date: <br /> Signature of Owner: Date: o <br /> c <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> n <br /> ➢ Does parcel require a Survey? Yes No <br /> °0 ➢ Permit application fees submitted? ❑ Amount$ Receipt# <br /> t. ❑ Reconciles with Real Property Lister Yes No Date: <br /> a <br /> 0 <br /> If not,explain: <br /> A <br /> 0 <br /> a <br /> h <br /> Application pproved / nied Reason for Denial: <br /> Land Use: Date: <br />