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Fees (must accompany frim): <br />Burnett County Subdivision Permit Application Subdiz sianWlo 5=Vn: $50-00 <br />Ssuce-f of Existing rarcd: $50.0040 <br />and/or Pre -Application Form Sub&vWonwt : $20000+s50.001d <br />Owner: Thomas 1 Grashorn Bayer: <br />Address: 2374 Erin Ct Address: <br />New Brighton, MN 55112 <br />ph„np, (651)247-8965 — Phage_ <br />Oridnal Parcel Information <br />Parcel II? #: 07-018-2-39-16-34-3 02-000-011000 section 34 Township 39N Range 16W <br />Original Description (or attach copy): NW CSA! <br />Current Zoning: A2 Floodplain Y/N: N _ _ Wetlands Y/N: N Lake/River Glass: N/A <br />Name of Water Body: N/A Shoreland AzreementlSIPS y/N, N <br />Farmland Preservation Y/N: N Managed Forestry Law Y/N: N <br />New Parcel Information <br />Proposed New Legal Description and Parcel Size: New 1 Lot CSM: N 1/2 N W S W <br />Acres: 5.04 <br />(If parcel is to be surrey ed, provide preliminary map. See attached for preliminary map requirements,) <br />Proposed access to public road: Existing <br />Proposed access to public waters to be provided Y/N: N/A <br />If yes, describe access: <br />Signature of Owner: 7u-%,� Date- <br />$' -16-18 <br />Signature of Owner: Date: <br />i Does parcel meet Zoning Requirements? Yes No `I/Z-7/li <br />> Does parcel require a &rve}? Yes No C 4� / 7 G 2— <br />> <br />i' Ferasit application submitted? ❑ Amount $ � S� ' Receipt # <br />❑ Reconciles with Real Property Lister Yes No Date: <br />If not, explain: <br />R <br />e <br />Applicatlo - prove -Denied Reason for Denial: <br />