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Fees (must accompany form): <br />Burnett County Subdivision Permit Application Subdivisionw/o Survey: $50.00 <br />Survey of Existing Parcel: $50M/Iot <br />and/or Pre -Application Form Subdivision w/ Survev: $200.00+$50.0011ot <br />Owner: Timothy Mulcare <br />Address: 7229 177th Ave NE <br />Forest Lake MN 55025-8875 <br />Phone: 651-464-4489 <br />Buyer: Bruce Howe <br />Address: 224 Grand Ave <br />New Richmond, W! 54017 <br />Phone: (715)781-2144 <br />Original Parcel Information <br />07-030-2-38-16-03-5 15-474-016000 <br />Parcel ID #: Q7-030-2-38-16-03-5 15-474-015000 Section 03 Township 38 Range 16 <br />Original Description (or attach copy): <br />Second Addition to Mound Beach Lot 11 Block 1 & that part Lot 1 CSM V2 P3 ©esc in 506/38 <br />& Second Addition to Mound Beach Lot 10 Block 1 <br />Current Zoning: RR1 Floodplain Y/N:__Wetlands Y/N: Lake/River Class: <br />Name of Water Body: Clam Lake Shoreland Agreement/SIPS Y/N: <br />Farmland Preservation WIN: Managed Forestry Law Y/N: <br />New Parcel Information <br />Proposed New Legal Description and Parcel Size: New 2 lot CSM shifting 40 feet of shore line <br />(0.059 acres) from Lot 11 to Lot 10 <br />Acres: 2.1 <br />(If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Proposed access to public road: G <br />m <br />Proposed access to public waters to be provided WN: <br />A <br />If yes, describe acce <br />Signature of Owner: Date: Z <br />Signature of Owner: /ZS�<—� _ Date: <br />B <br />Does parcel meetl&ling Requirements? Yes No <br />X77 .� <br />] Does parcel require a Survey? Yes No <br />is S of <br />0° D Permit application fees submitted? ❑ Amount $ Receipt # <br />r. ❑ Reconciles with Real Property Lister Yes No Date: <br />m <br />a' If not, explain: <br />A <br />0 <br />Applicat' : Approved Denied Reason for Denial: <br />Land <br />Date: <br />