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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 $50.00Not <br />and/or Pre -Application Form Subdivision w/Survev: $200.00+$50.00/lot <br />m <br />0 <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 />07-03S-2-41-14-28-5 15-847-021000 <br />o7 -03e-2-4 '4-28-5 15 sal-0zooao Section 28 Township 41 Range 14 <br />Parcel ID #: 07_038-,-41-14-28-5 I=7 oz� O _ �_ g <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 Shorcland Agreement/SIPS YIN: <br />Farmland Preservation Y/N: - <br />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. See attached for preliminary map requirements.) <br />Proposed access to public road: p <br />m <br />Proposed access to public waters to be provided YIN: A <br />If yes, describe access: o <br />Signature of Owner: JDate: <br />c,Q <br />Signature of Owner:Date. <br />a <br />b <br />➢ Does parcel meet Zoning Requirements? Yes No <br />Y Does parcel require a Survey? Yes No /0 7,? <br />ov <br />Permit application fees submitted? O Amount $ io©i Receipt # <br />❑ Reconciles with Real Property Lister Yes No Date: <br />If not, explain: <br />Applicata Approved nied Reason for Denial: <br />Land <br />Date: <br />