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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/Survey: $200.00-$50.00/lot <br /> Owner: John Ackelson Buyer: Daniel Ries ,z <br /> n <br /> Address: 5920 Blackberry Brdg PthAddress: 27617 Thompson Bay Rd 3 <br /> Inver Grove Hgts MN 55076 Webster WI 54893 z <br /> oU. <br /> Phone: 612-991-5604 Phone: 715-866-4401 <br /> Original Parcel Information <br /> 07-012-2-40-15-36-5 05-002-014000,07-012-2-40-15-36-5 05-002-017000 6L <br /> Parcel ID#: Section 36 Township 40N Range 15W -4 <br /> O <br /> Original Description(or attach copy): Lot 1 CSM V10 P39 (GL 2 Fmly CSM V2 P49), Lot 4 <br /> CSM V2 P49 GL2 ;;C..- <br /> 0 <br /> T <br /> Current Zoning: RR1 Floodplain Y/N: Y Wetlands Y/N: N Lake/River Class: p <br /> c <br /> n' Name of Water Body:,North Sand Lake Shoreland Agreement/SIPS Y/N: , <br /> .. Farmland Preservation YIN: N Managed Forestry Law YIN: N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: CSM changing lot lines on 2 existing parcels <br /> Acres:3.22 ' <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) V' <br /> Proposed access to public road: p <br /> n <br /> Proposed access to public waters to be provided Y/N: O <br /> If yes,describe access: <br /> G <br /> Signature of Owner: Date: <br /> Signature of Owner: Date: © <br /> 3 <br /> e <br /> > Does parcel meet Zoning Requirements? Yes No IZ.G c- 9/ Z5' F <br /> N <br /> > Does parcel require a Survey? Yes No .02.,,i/ <br /> IS• i <br /> > Permit application fees submitted? ❑ Amount S /d 0• <br /> � Receipt# <br /> 0 <br /> Reconciles with Real Property Lister es No Date: 9-2$-2Q M <br /> w <br /> If not,explain: "Them appears k be scene +vile. tssuse W/ Ackelsan's parcel. <br /> n QC) <br /> © <br /> ti <br /> Applicatio , pproved / i enied Reason for Denial: <br /> Land Use: `-1 /0///20 u Date: <br />