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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: $50.001lot <br /> and/or Pre-Application Form Subdivision w/Survev: $200.00+$50.00/lot <br /> Owner: Keith&Lynn Anderson Buyer: <br /> Address: 8111 Oakview Dr.N Address: <br /> Maple Grove,MN 55369 z <br /> e <br /> 612-802-5826 C <br /> Phone: Phone: <br /> Orizinal Parcel Information <br /> Parcel ID#: 07-042-2-38-18-34-5 05-007-012000 Section 34 Township 38 Range 18 <br /> O <br /> Original Description(or attach copy): Lots 1 &2 of CSM Vol. 1,Pg.85 <br /> ya Current Zoning: RR I Floodplain Y/N: Y Wetlands YIN: Y Lake/River Class: <br /> b <br /> m Name of Water Body: Wood Lake Shoreland Agreement/SIPS Y/N: N <br /> 0 <br /> T Farmland Preservation Y/N: N Managed Forestry Law Y/N: N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: Lot I of Pending CSM <br /> Acres: 0.46 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: Via existing access(see pending CSM for details) C <br /> Proposed access to public waters to be provided Y/N: N <br /> If yes,describe access: q <br /> Signature of Owner. Date: <br /> �LL <br /> Signature of Owner: Date: 3 <br /> V <br /> G <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> lk <br /> c /llto <br /> ➢ Does parcel require a Survey? Yes No <br /> °fQ ➢ Permit application fees submitted? O Amount$ w Receipt# <br /> t., ❑Reconciles with Real Property Lister Yes No Date: <br /> m <br /> 0 <br /> ° if not,explain: <br /> n <br /> 0 <br /> ti <br /> a <br /> Applicatio . Approved / Denied Reason for Denial: <br /> Land Use: - Date: © Z 2�� <br />