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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+$50.00/lot <br /> Owner: Larry& Mary Johnson Buyer: <br /> co <br /> Address: 10435 132nd St E Address: 3 <br /> Hastings MN 55033 0 <br /> Phone: 651-442-3610 Phone: <br /> Original Parcel Information <br /> Parcel ID#: 07-030-2-38-16-17-5 05-211-013000 Section 17 Township 38N Range 16W <br /> 0 <br /> Original Description(or attach copy): Forgotten Tymes Lot 3 <br /> .d Current Zoning: RR1 Floodplain Y/N: Y Wetlands Y/N:Y Lake/River Class: <br /> b <br /> g: Lon Lake 3 <br /> W Name of Water Body: g Shoreland Agreement/SIPS Y/N: <br /> „s- <br /> Farmland <br /> Farmland Preservation Y/N:N Managed Forestry Law Y/N:N <br /> New Parcel Information C.. <br /> V <br /> Proposed New Legal Description and Parcel Size: CSM divide in 2 parse's <br /> v) <br /> 3' <br /> Acres: 13.93 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: C <br /> a <br /> F <br /> Proposed access to public waters to be provided Y/N: 0 <br /> If yes, describe access: <br /> Signature of Owner: Pn/d.,-c e, - 1,-.., Date: i OI 0`{- ‘70 (5 <br /> De <br /> Signature of Owner: &-3.1.3-N.X.A 01) ` ' ♦�ti,�..,_ Date: 1 Ve�lzs°"2-0 o <br /> > Does parcel meet Zoning Requirements? Yes No G(`'i4 6e z -5-7 <br /> > Does parcel require a Survey? Yes No ` <br /> O% <br /> 0D i Permit application fees submitted? 0 Amount$ Z✓`), Receipt# <br /> 5 Reconciles with Real Property Lister No Date: le/(Z/2.0 0 <br /> E) <br /> a <br /> C <br /> If not,explain: <br /> 7 <br /> n <br /> n <br /> on <br /> ca. <br /> y <br /> Applicatio•. •ppro .• / Denied Reason for Denial: <br /> Land Use: , fr /3 0.0 eV Date: <br />