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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 Parcels $50.00/lot <br />and/or Pre -Application Form Subdivision w/ Survev. $200.00+ $50.00/lot <br />Owner: Shelter from the Dorm LLC Buyer: <br />Address: 1521 Tamberwood Trl Address: <br />Woodbury, MN 55125 <br />Phone: 612-802-7491 Phone: <br />Original Parcel Information <br />07-038-2-41-14-28-5 15-84T-021000 <br />Parcel ID #: 07-0122-441-14-28-5 15.847-020000 Section 2$ Townshi 41 Range 14 <br />07.0 1- 14_21}s 1s 847 022000 g <br />Original Description (or attach copy): Whispering Pines Lots 11, 12, & 13 of Block 1 <br />Current Zoning: RR1 Floodplain Y/N:_yWetlands Y/N: Y Lake/River Class: - <br />Name of Water Body. Des Moines Lake Shorcland 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 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. Sec attached for preliminary map requirements.) <br />Proposed access to public road: C <br />m <br />Proposed access to public waters to be provided Y/N: e� <br />If yes, describe access: <br />Signature of Owner: Date: O� <br />Signature of Owner: A, Date: o <br />a <br />➢ Does parcel meet Zoning Requirements? Yes No 6 <br />Y Does parcel require a Survey? Yes No /�� 7,? S <br />OJ <br />Permit application fees submitted? ❑ Amount S f7©i Receipt # <br />❑ Reconciles with Real Property Lister Yes No Date: <br />If not, explain: <br />Applicata Approved nied Reason for Denial: <br />Land UseDate: <br />