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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: $50,00 <br /> and/or Pre-A lieation Form Survey of Existing Parcel: $50.00/lot <br /> pp Subdivision w/Survev: $200.00+$50.00/lot <br /> Owner: Kenneth & Linda Sipe Buyer: Brent Kelsey (BK Properties, Inc.) <br /> b <br /> Address: 1759 Helena Road Address: 100 Buchanan St N 9 <br /> 2 <br /> Oakdale, MN 55128 Cambridqe, MN 55008 <br /> Phone: ( ' .7 Phone: 651—755—4459 <br /> Orhdnal Parcel Information <br /> Tax ID: 25543 ' <br /> Parcel ID#: 07-036-2-40-17-36-5 15-704-012000 Section 36 Township 40 Range 17 <br /> Original Description(or attach copy): See ottached <br /> ;s <br /> Y ?� <br /> b <br /> Current Zoning: R R 1 <br /> l; Floodplain Y/N: Wetlands Y/N: <br /> �1 <br /> Lake/River Classification: Name of Water Body: R <br /> Shoreland Agreemt or SIPS Y/N: Farmland Preservation Y/N: Managed Forestry Law Y/N: P <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: _Lots 21 and 22, Proposed CSM (�1 <br /> Acres: 3 cc & 1 a c <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: Shady Glen Road C <br /> Proposed access to public waters to be provided Y/N: <br /> If ves,describe access: 101 <br /> Signature of Owner: Date: <br /> Signature of Owner: , Date: o <br /> 9 <br /> ➢ Does parcel meet Zoning Requirements?" Yes No J ' 3 l a <br /> --' Does parcel require a Survey? Yes No Cu 5 <br /> o' <br /> aro <br /> ➢ Permit application fees submitted? ❑ Amount S Od . Receipt# <br /> �1 <br /> ❑ Reconciles with Real Property Lister Yes No Date: <br /> a <br /> XIf not,explain:_ <br /> 0 <br /> a <br /> Applicatio Approved / ented Reason for Denial: <br /> Land Use: �� Z4� Date: <br />