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Burnett County Subdivision Permit Application <br />Fees (must accompany form): <br />and/or Pre -Application Form or Ma Review Form <br />ph P <br />Subdivision w/o Survey: $50.00 <br />Survey of Existing Parcel: $50.00/lot <br />Subdivision w/ Survev: $200.00 + $50.00/lot <br />Jane Pederson <br />Owner: <br />Address: <br />Phone: <br />1937 Selby Av. <br />St. Paul, MN 55014 <br />952-890-8838 <br />Buyer: <br />Address: <br />Phone: <br />Original Parcel Information <br />Parcel ID #: 034 1502 02300 Section 2 Township 37 Range 18 <br />Original Description (or attach copy): Parcel described in Document No. 410159, <br />located in Gov. Lots 2, Section 2, T37N-R18W. <br />Current Zoning: RR -1 Floodplain Y/N: Y Wetlands Y/N: N Lake/River Class: 1 <br />Name of Water Body: Spirit Lake Shoreland Agreement/SIPS Y/N, N <br />Farmland Preservation Y/N: N Managed Forestry Law Y/N:: 1 N <br />New Parcel Information va oZ% I 94—,96— <br />Proposed New Legal Description and Parcel Size: This is a CSM of an existing parcel. <br />Acres: 1.14 <br />(If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Proposed access to public road: Direct Access to Spirit Lake Road East. <br />Proposed access to public waters to be provided Y/N: N <br />If yes, describe access: <br />Signature of Owner: N/A Not a Subdivision Date: <br />signature of uwner: hate: <br />➢ Does parcel meet Zoning Requirements? Yes No <br />➢ Does parcel require a Survey? Yes No <br />Permit application fees submitted? ❑ Amount $ —522A �d Receipt # <br />❑ Reconciles with Real Property Lister Yes No Date: <br />If not, explain: <br />Application: rXpproved / enied Reason for Denial: <br />Land Use: /'7 Date: <br />