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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision vv/o Survey: $50.00 <br /> Survey of Existing Parcel: $50.00/lot <br /> and/or Pre-Application Form Subdivision Nv/Survev: $200.00+$50.00/lot <br /> Owner: Robert Lindell Buyer: <br /> �d <br /> Address: 5158 Sheridan Ave N Address: <br /> Minneapolis MN 55430 0 <br /> cl' <br /> G <br /> Phone: Phone: <br /> Original Parcel Information _D <br /> 1 <br /> 07-036-2-40-17-09-5 05-008-011000 07-036-240-17-09-5 05-008-012000 'J <br /> Parcel ID#: Section 09 Townshi 4p ON Range 17VV ^h <br /> O <br /> Original Description(or attach copy): Pcl Gov Lots 6 & 8 (Lot 6) & Pcl Gov Lot 8 (Lot 5) <br /> '7J <br /> .> Current Zoning: RR2 Floodplain Y/N: N Wetlands Y/N: N Lake/River Class: -� <br /> Name of Water Body: Bluff Lake Shoreland Agreement/SIPS Y/N: N <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N: N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: CSM Combining 2 parcels Into 1 <br /> Acres: 1 .50 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> Proposed access to public waters to be provided Y/N: <br /> If yes, describe access: v1 <br /> g 77' ) <br /> Signature of Owner: Z Date: <br /> Signature of Owner: Date: o <br /> c <br /> Does parcel meet Zoning Requirements? Yes No <br /> c ➢ Does parcel require a Survey? Yes No <br /> Permit application fees submitted? ❑ Amount$ 1{ i <br /> r. ❑ Reconciles with Real Property Lister Yes No Date: �C lVi <br /> NOV 12019 <br /> If not,explain: <br /> c. Burnett County <br /> 11 Lana Services Department <br /> Applicatio . Approved / enied Reason for Denial: <br /> Land Use: /Z �� Date: <br />