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Fees (must accompany form): <br />Burnett -County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br />and/or Pre -Application Form Survey of Existing Parcel: $50.00/lot <br />PP Subdivisionw/Survev: <br />$200.00+$50.00/lot <br />r�7 <br />Owner: (1o�01 f- �- �n yea Buyer: <br />�QIt"' �{ y <br />Address- Address: <br />t Address: <br />o <br />S�i��wc��er MN Eb0RQ,, z <br />( 2� <br />Phone: l� 3 X1- Phone: <br />C� <br />Oridnal Parcel Information <br />ap <br />Parcel ID #: o7- oi8-a-37-Ila-ot-1 - S nS-ed2 o24ec&ectionL4 Township �9 Range 11 <br />sU <br />Original Description(orattachcopy): i�CL (r�O�t 1c,4� ZT(p. <br />O <br />eS m k L41 P, <br />Current Zoning: ►2R 1 Floodplai�' Wetlands �Lake/River Class: <br />-�+- <br />Ci <br />`. <br />Name of Nater Body: �QV L.a ilk Shoreland Agreement/SIPS YIY: <br />o <br />Farmland Preservation i Managed Forestry Law Y <br />S <br />P <br />New Parcel Information <br />S <br />`` <br />Proposed New Legal Description and Parcel Size: ice._ 1 L4- CSM <br />� <br />ID <br />Acres � + 5 <br />(If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Proposed access to public road: <br />Proposed access to public waters to be provided YIN: <br />If yes, describe access: <br />t <br />l,J <br />t <br />07122 <br />Robert W. Herzfeld 7 ' <br />Signature of Owner Date: 02:58 PM CDT <br />Q <br />07/22/2018 <br />Signature of Owner: Donna M. Herzfeld „fig Date 03:00 PM CDT <br />00 <br />c <br />➢ Does parte( meet Zoning Requirements? Yes NoG� %�uorl g <br />N <br />g� <br />➢ Does parcel require a Survey? ZZ <br />Yes No <br />�' <br />Os <br />➢ Permit application fees submitted? ❑ Amount S®' Receipt # <br />r <br />❑ Reconciles with Real Property Lister Yes No Date: <br />v <br />a <br />If not, explain: <br />0 <br />G <br />Application Approve ! Denied Reason for Denial: <br />