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Fees(must accompanv form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br /> and/or Pre-A lication Form Survey of Existing Parcel: $50.00/lot <br /> PP Subdivision w/Survev: $200.00+$50.00/lot <br /> Owner: Matthew Edward Thomoson wnxr Randall Allen Schmieq <br /> -e <br /> Address: 9578 Cottontail Drive Address: 1599 Birch Street <br /> St. Bonifacius, MN 55375 Hugo, MN 55038 0 <br /> 0) <br /> Phone: 612 802-7642 Phone. 651 274-1731 CM <br /> Original Parcel Information ITI <br /> Sv <br /> Parcel ID#: 07-017-9-40-15-19-r, 0_S-MI-011000 Section--19--Township 40N Range 15W <br /> O <br /> Original Description(or attach copy): copy of Doc . #381936 attached <br /> 0 <br /> A <br /> RR-z a� 3 <br /> Current Zoning: A-2- Floodplain Y/N: Wetlands Y/N: Lake/River Class: <br /> m Name of Water Body: Crystal Lake Shoreland Agreement/SIPS Y/N: N �- <br /> o <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N: N <br /> New Parcel Information <br /> r <br /> Proposed New Legal Description and Parcel Size: see attached de criptions <br /> Acres: 10 and 7.85 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: Bushey Road p <br /> v <br /> Proposed access to public waters to be ovided Y/N: Y A <br /> If yes, describe access:\ tdl ake � <br /> Signature of Owner: Date: ' � ( 1 — Z <br /> Z)/ r <br /> a w Laward I hon <br /> Signature of Owner: 4 A 1S Date: S / z ll <br /> Kannall All Scnmieq <br /> C <br /> > Does parcel meet Zoning Requirements? C Yes No <br /> N � <br /> > > Does parcel require a Survey:? Yes No h <br /> o � � <br /> Q0 i Permit application fees submitted? Amount Receipt# 1 �q <br /> SJ <br /> I <br /> r ❑ Reconciles with Real Property Lister V No Date: �) <br /> If not,explain: a <br /> 'o <br /> c <br /> Application: Approve enied Reason for Denial: <br /> Land Use: µ --�_ Date: <br />