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Burnett County Subdivision Permit Application Fees (must accompany form): <br />and/or Pre -Application Form or Ma Review Form Subdivision w,'o Survey: $50.00 <br />pp p Survey of Existing Parcel: $50.00/lot <br />Subdivision w./ Survev: 5200.00 + 550.00/lot <br />Hugh Schilling <br />Owner: Buyer: <br />Address: PO BOX 131750 Address: <br />ROSEVILLE MN 55113 <br />Phone: <br />Phone: <br />Original Parcel Information <br />Parcel ID #: 030233002800 Section 30 Township 38 Range 16 <br />Original Description (or attach copy): LOT 1 CSM V 2 P 119 & LOT 1 CSM V 5 <br />2 <br />Current Zoning: Floodplain Y/N: N Wetlands Y/N: N Lake/River Class: <br />Name of Water Body: Shoreland Agreement/SIPS Y/N: N <br />Farmland Preservation Y/N: Managed Forestry Law Y/N: <br />N <br />New Parcel Information <br />Proposed New Legal Description and Parcel Size: We are submitting a new CSM that <br />the two previous CSMs into one lot and adjusts the east boundary to a new <br />boundary agreement accomplished by deed. Acres: 11.04 <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 Elbow Lake Road <br />Proposed access to public waters to be provided Y/N: N <br />If yes, describe access: <br />Signature of Owner: N/A Date: <br />6ignature of towner: mate: <br />➢ Does parcel meet Zoning Requirements? Yes No R e r-- 3/y /w <br />➢ Does parcel require a Survey? Yes No <br />mo <br />� Permit application fees submitted? ❑ Amount $ S0 • Receipt # <br />❑ Reconciles with Real Property Lister Yes No <br />If not, explain: <br />Date: <br />Application • Approved / Denied Reason for Denial: <br />Land Use: Date: <br />0 <br />S <br />S <br />