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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/Smvev: S200.00+$50.00'lot <br /> Owner: Kellie Cardinal Buyer: <br /> b <br /> Address:2197 Ash St Address: 3 <br /> White Bear Lake MN 55110 0 <br /> Phone: 651-485-1113 Phone; lCA <br /> Original Parcel Information <br /> Parcel ID#• 07-008-.3""75o6QU,-03700007-006-2-38-,7.,7-505-0o,-038000 17 38N 17W <br /> • Section Township Range <br /> Original Description(or attach copy): Lot 4 (in Gov Lot 1)& PCLS Gov Lot 1 4 <br /> A <br /> V Current Zoning: RR1 Floodplain Y/N: Y Wetlands Y/N: Y Lake/River Class: <br /> b <br /> aName of Water Body: Mud Hen Lake Shoreland Agreement/SIPS Y/N; <br /> Farmland Preservation Y/N:N Managed Forestry Law Y/N:N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: CSM changing lot lines on 2 existing parcels <br /> Acres: 1.40 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: C <br /> m <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: <br /> Signature of Owner: r (_!� Date: <br /> 11� <br /> Signature of Owner: Date: /d <br /> 0 <br /> G <br /> ➢ Does parcel meet Zoning Requirements? Yes No � <br /> ➢ Does parcel require a Survey? Yes No <br /> � / N <br /> ➢ Permit application ftes submitted? ❑ Amount$ /W Receipt#d(,# <br /> ❑Reconciles with Real Property Lister Yes No Date: <br /> CD <br /> If not,explain: n <br /> o � � <br /> C � � <br /> m'? <br /> Application: Approved / Denied Reason for Denial: o°c e <br /> Land Use: Date: *W1 <br /> s�itc.� sly a 1�2, 10,Do 17 C� m�0ab F a1�, <br />