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Fees (must accompany form): <br />Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br />Survey of Existing Parcel: $50.00/lot <br />and/or Pre -Application Form Subdivision w/ Survev: $200.00+$50.00/lot <br />Owner: Sarah S Henke Revocable Trust Buyer: <br />Address: 11955 102nd St N Address: <br />Phone: <br />Stillwater, MN 55082 <br />651-250-4910 (Brian Henke) <br />Phone: <br />Tax ID: 34848 Original Parcel Information <br />Parcel ID #: 07-026-2-39-15-02-102-000-014100 Section 2 Townshi 3p 9\ Range I5'V <br />Original Description (or attach copy): The north 9636' of the south 470.41 feet of GL 1 and the NW -NE and a <br />parcel described in Document #448775 (Judgment), excepting the westerly 400 feet of the NW -NE. <br />Current Zoning: RRl, F1 Floodplain Y/N: Y Wetlands Y/N: Y Lake/River Class: <br />Name of Water Body: Mallard Lake Shoreland Agreement/SIPS Y/N: N' <br />Farmland Preservation N'/N: N <br />Managed Forestry Law Y/N: <br />New Parcel Information <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 are being created. The deed of Outlot 1 to the neighbor (Hoey) 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: <br />Date: <br />b <br />3 <br />z <br />0 <br />O <br />s <br />z <br />v <br />y <br />Signature of Owner: Date: o <br />e <br />➢ Does parcel meet Zoning Requirements? Yes No Gc, 7 / Z'7 <br />D -S ➢ Does parcel require a Survey? Yes No <br />Permit application fees submitted? ❑ Amount $ Receipt # <br />�. ❑ Reconciles with Real Property Lister Yes No Date: <br />D <br />77 <br />If not, explain: <br />n <br />0 <br />c <br />Application: Approved / Denied Reason for Denial: <br />Land Use: Date: <br />