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1. 12()3Fees(must accompany form): <br /> V .00 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+$50.00/lot <br /> Owner The 2014 Sandberg Irrevocable Trust Buyer: b <br /> A <br /> Address:5965 Turtle Lake Rd Address: a <br /> Shoreview MN 55126 0 <br /> 612-916-7123 <br /> Phone: Phone: tN7 <br /> Original Parcel Information <br /> Parcel m#: 07-010-2-38-19-09-3 04-000-012000,011000 Section 09 Townshi3p 8N Range 19W it <br /> O <br /> Original Description(or attach copy): SE-SW a <br /> a <br /> et <br /> XI <br /> .d Current Zoning: A2 Floodplain Y/N: N Wetlands Y/N: N Lake/River Class: Q <br /> c <br /> oName of Water Body: N/A Shoreland Agreement/SIPS Y/N: f <br /> Farmland Preservation Y/N:N Managed Forestry Law Y/N:N O- <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: CSM changing lot lines on 2 existing parcels <br /> Acres:8.00e <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> - ' <br /> Proposed access to public road: <br /> a <br /> t <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: 151 <br /> Signature of Owner: /j(., !1/ t t_'J,a/.; / I ! ' i ; Dae : /©— —zezo <br /> � tl , , i, . <br /> Signature of Owner: Date: o <br /> B <br /> > Does parcel meet Zoning Requirements? Yes No C 6 O 2-7 7 <br /> sl <br /> ➢ Daoes parcel require a Survey? Yes No <br /> a o D � X0 <br /> Permit application fees submitted? 0 Amount$ Z,522, Receipt# .„p <br /> a <br /> t ®Reconciles with Real Property Lister es No Date: 1113f20 <br /> o. If not,explain: <br /> r <br /> C <br /> 0 <br /> a <br /> Application: •oved I enied Reason for Denial: <br /> c <br /> Land Use:y4......4-------'4—� /// .F.,0 Z. ' Date: <br />