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Burnett County Subdivision Permit Application <br />and/or Pre -Application Form or Map Review Form <br />Fees (must accompany form): <br />Subdivision w/o Survey: $50.00 <br />Survey of Existing Parcel: $50.00/lot <br />Subdivision w/ Survev: 5200.00 + S50.00/lot <br />P <br />Owner: Michael Johnson/Lois Johnson Buyer: Patti L. Blatz/David I. Blatz �? <br />Address: 1383 Thelen Farm Trail/8151 Henna Ave. S. Address: 119 E.8th St. �► <br />Phone: <br />Hastings, MN 55033 00 <br />Phone: (781)_572-5764 <br />Original Parcel Information <br />Parcel ID #: 07-018-2-39-16-03-4 03-000-0-1-000 Section 3 Township 39N Range 16W <br />Original Description (or attach copy): The SW '/ SE '/. Section 3. Township 39 North, Range 16 West, <br />Current Zoning: Floodplain Y/N: No Wetlands Y/N: Yes Lake/River Class: <br />Name of Water Body: Shoreland Agreement/SIPS YIN: <br />Farmland Preservation Y/N: N Managed Forestry Law Y/N: N <br />New Parcel Information <br />Proposed New Legal Description and Parcel Size: See Addendum A <br />Acres: 9.8 <br />(If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Proposed access to public road: Austin Lake Road <br />Proposed access to public waters to be provided Y/N: <br />If yes, describe access: <br />Signature of Owner: Date: d—z / - r 0 <br />Signature of Owner: Date: C5-. z -e'-- osr <br />➢ Does parcel meet Zoning Requirements? <br />➢ Does parcel require a Survey? <br />Yes No vk *- 1507-7 <br />Yes No <br />)�' Permit application fees submitted? ❑ Amount $ <br />� 1 <br />ElReconciles with Real Property Lister Yes Date: <br />If not, explain: <br />Applicatiop= " pr evo d / Denied Reason for /Denial: _ <br />Land Use: <br />91716 <br />Receipt # <br />fa1Lit�t cf Por s <br />