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Fees (must accompany form): <br />Burnett County Subdivision Permit Application S.Wilision w/o Survey: 550.00 <br />Survey of Existing Parcel: S50.00.10t <br />and/or Pre -Application Form Subdivision w, Survev: s2001r) + 550M,l„t <br />Sarah S Henke Revocable Trust <br />Owner: Buyer: <br />Address: 11955 102nd St N Address: <br />Stillwater, MN 55082 <br />Phone: 651-250-4910 (Brian Henke) <br />Phone: <br />Tax ID: 34848 Original Parcel Information <br />Parcel ID #• 07-026-2-39-15-02-1 02-000-014100 Section -' Township 39N Range 151' <br />Original Description (or attach copy): The north 96.36' of the south 470.41 feet of GL I andtheNl%'-NE.Jnda <br />parcel described in Document #448775 (Judgment), excepting the westerly 400 Icet of the NW -NE. <br />Current Zoning: RR I - F 1 Floodplain Y/N: Y Wetlands Y/N: y Lake/River Class: <br />Name of Water Body: Mallard Lake Shoreland Agreement/SIPS Y/N: <br />Farmland Preservation YIN: N Managed Forestry Law Y/N: N <br />New Parcel Information h <br />Proposed New Legal Description and Parcel Size: Lot 1 (2.65 acres) and Outlot 1 (0.72 acres) of new CSM. <br />The purpose of this CSM is to aid in the transfer of lands between adjacent land owners to clean up record title <br />issues. No new parcels arc being created. The deed of Outlot I to the neighbor (Hocy) will include the language: <br />"this parcel is to be attached and not sold separately ...” Acres: 3.37 <br />(If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Proposed access to public road: Existing access road - apparent easement <br />Proposed access to public waters to be provided Y/N: N <br />If yes, describe access: <br />Signature of Owner: r v' Date: 71 z- ci <br />Signature of Owner: Date: <br />Does parcel meet Zonacc/nirements' Yes hn ReCtk-':;l-�OI� <br />0 r Does parcel require a Surver" yes No <br />va ;. <br />Permit application -fees stihutitte(l, ❑ <br />.. ❑ Reconciles with Real Property Lister Yes No Date: <br />r, <br />a <br />0. if not, explain:_ <br />n <br />a <br />'l. <br />Application::lpproved / Denied Reason for Denial: — <br />Land Ilse:!_ Date: 8 O <br />