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Fees(must accompany form): <br /> Burnett County Subdfivision Permit Application Subdivision w/o Survey: $50.00 <br /> and/or Pre- lication Form Survey of Existing Parcel: $50.00/lot <br /> pp Subdivision w/Survev: $200.00+$50.00/lot <br /> Owner: Bonnie Eggleston <br /> Buyer: ro <br /> Address: 11460 Zion Rd Address: 3 <br /> Bloomington MN 55437 0 <br /> Phone: Phone: C <br /> Original Parcel Information p <br /> Parcel ID#• 07-032-2-41-16-25 5 15-701-020000 <br /> 1 Section 25 Townshi 4p 1 N Range 16W <br /> Original Description(or attach copy): First Add to Selma Lea Acres Lot 29 <br /> a RR2 Flood lain Y/N: Y Wetlands Yam: N Lake/River Class: 7 <br /> b Current Zoning: <br /> aName of Water Body: Burlinga e Lake Rd Shoreland Agreement/SIPS Yam:N <br /> Farmland Preservation Y/N:N Managed Forestry Law Y/N:N I <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: Combine Lot 29 &Lot 30 <br /> Acres: 1.81 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road:EX sting C <br /> 'y <br /> Proposed access to public waters to be provided YJN:N <br /> If yes,describe access: <br /> Gl <br /> Signature of Owner: 08:00 PM CDT <br /> Date: <br /> 08/19/2019 <br /> Signature of Owner: r ✓° 08:02 PM CDT n <br /> Date: c <br /> b <br /> ➢ Does parcel meet Zoning Requir menu? Yes No ° <br /> ➢ Does parcel require a Survey? Yes No <br /> °q ➢ Permit application fees submitte ? ❑ Amount S �0 1 Receipt# <br /> ❑Reconciles with Real Property L' ter Yes No Date: V <br /> o If not,explain: <br /> o <br /> c <br /> W <br /> Applicatio �pprovedDenied Reason for Denial: <br /> Land Use: Date: <br />