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From: 1 Office Phone Fax: 16512221201 To: Fax: (715) 866-4206 Page: 2 of 2 11/29/2018 11:56 AM <br />Fees (must accompany form): <br />Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br />Survey of Existing Parcel:5 $50.00/lot <br />and/or Pre -Application Form Subdivision w/ Survey: $200.00+ $50.00/lot <br />Owner: Shelter from the Dorm LLC <br />Address: 1521 Tamberwood Trl <br />Buyer: <br />Address: <br />Woodbury, MN 55125 <br />Phone: _ 612-802-7491 Phone: <br />Original Parcel Information <br />07-038-2-41-14-28-5 15.84 7-021000 <br />'-4 "' �NSection 28 Townshi 41 Range 14Parcel ID #: 0n77-013t2�411_ta?X51RoO <br />Original Description (or attach copy): Whispering Pines Lots 11, 12, & 13 of Block 1 <br />Current Zoning: RR1 Floodplain Y/N:_yWetlands YIN: Y Lake/River Class: <br />Name of Water Body. Des Moines Lake Shortland Agreement/SIPS Y/N: <br />Farmland Preservation Y/N: - Managed Forestry Law Y/N:' <br />New Parcel Information <br />Proposed New Legal Description and Parcel Sue: New 2 Lot CSM Combining Lots 11 & 12 Block 1 of <br />Whispering Pines <br />Acres: <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 Y/N: <br />If yes, describe access: <br />Signature of Owner: <br />Signature of Owner: <br />Date: /� /% g <br />➢ Does parcel meet Zoning Requirements? yes No <br />Y Does parcel require a Survey? Yes No /\ �� % 8 <br />0 <br />Permit application fees submitted? O Amount $ 106/ Receipt # <br />❑ Reconciles with Real Property Lister Yes No Date: <br />If not, explain: <br />Applicati Approved nied Reason for Denial: <br />Land Use: <br />Date: <br />v <br />m <br />'4101 <br />aqv, <br />W <br />