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Fees (must accompany form): <br />Burnett County Subdivision Permit Application sumvisionwJosuvey S50.00 <br />and/or Pre—A plication Form Sm-veyofExis1mgPartx1: $50.00/lot <br />PP Subdivision w/ Survev $200.00 + S50.(K)not <br />Owner: Joanne Grefsrud <br />Buyer: Cheryl Canfield <br />Address:_ PO Box 85 Address: 10729 Buchanan St NE <br />Webster, Wi 54893 Blaine, MN 55434 <br />Phone: (763)742-5131 Pt,.,— 763-742-5131 <br />Original Parcel Information <br />Parcel ID #t: 07-026-2-39-15-31-5 05-013-011000 Section 31 Township39 N Range 15 W <br />Original Description (or attach copy): Gf)y Lot 13 EX GSM V9 Pgs 60 R 84 GSM V 11 P303 <br />(Sub' to Esfnnt #335082} <br />Current Zoning: RR1 Floodplain Y/N: N Wetlands Y/N: N Lake/River Class: - <br />Name of Water Body: Viola Lake Shoreland Agreement/SIPS YIN: <br />Farmland Preservation Y/N: - Managed Forestry Law Y/N: - <br />New Parcel Information <br />Proposed New Legal Description and Parcel Size: New 1 Lot CSM <br />Acres: 1.65 <br />(If parcel is to be surveyed, 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: <br />If yes, describe access: <br />;2 <br />Signature of Owner: qt7a4-C.,- 1 .�- ^_. Date: <br />Signature of Owner: _ Date: <br />r Does parcel meet .Luning Requirements? Yes No 9k. C, 12-1-7113- <br />;w <br />2. -7l3- <br />Drh s parcel require a Survey? Yes NO C4, 0 1 ? 72- 1�1 <br />O© <br />Permit application fees submitted? ❑ Amount S � � �- Receipt ## <br />❑ Reconciks with Real Property Lister Yes No-�__.--- <br />If not, explain: <br />Reason for Denis <br />