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Fees (must accompany form ): <br />Burnett County Subdivision Permit Application Subdiiision«%oSun-ey: S50.(10 <br />Survcv of F.xiqinx Parcel: S%001110t <br />and/or Pre -Application Form Subdhvisionxcr Survev: S200.00—S50.00'lot <br />Ovmer Lot 11 R tees' half of Lot 11) (Proposed Lot 2) <br />Owner: Josses Lindea Buver: <br />Address: 53 4th Ave N, #102 Address: <br />Minneaoois, PAN 55401 <br />Phone: ;612) 333-3166 Phone: <br />Orkinal Parcel Information <br />07-038-2-41-14-17-5 15-805-021001 <br />Parcel ID #: 07-038-2-41-14-17-5 15-805-023001 Section 17 <br />Township 41 Ranke 1 = ` <br />Original Description (or attach coPy): <br />_cts 9, 13 and 11, Block 3, Town of VVebb Lcke Assessor's Flat <br />Current Zoning: RR1 — Floodplain Y/N: Wetlands Y/N: <br />Lake/Rb,er Classification: Name of Water Bode: "'/ebb Lo.<e <br />Shoreland Agreemt or SIPS Y/N: _Farmland Preservation Y/N: [Managed Forestry Law Y/N: <br />New Parcel Information <br />`Proposed New Legal Description and Parcel Size: <br />Proposed CSN <br />Acres: 26 <br />(if parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Proposed access to public road: %`,' Webb Lctke Drive vio Rcinbovi Drive (a private road) <br />Proposed access to public waters to be provided Y/ -N: N <br />If ves, describe access: <br />Signature of Owner: , Date: <br />a tti►¢ 5 E. i N- � <br />Signature of Owner: Date <br />Does puree( meet Zonhrg Requirements.' Yes No <br />Does pcn•cel require a Strr•i�el•:' Yes ;Vo <br />r Permit application fees suhvnitred? ❑ Amount S Receipt # <br />❑ Reconciles with Real Property Lister Yes No Date: <br />If not, explain: <br />ApplicationApproved ! ied Reason for Denial: ~ <br />Land U <br />zev S' Da <br />f <br />