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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: S200.00+$50.00/lot <br /> William Graham <br /> Owner: . ..._ Buyer: " <br /> Address:9251 Hamlin AveAddress: B <br /> z <br /> Circle Pines MN 55014„ ., <br /> l' Phone: Phone;-,_ <br /> • <br /> W. ` rated It*1bnnat <br /> Parcel ID#: 07-036-2-40-17-36-515-420-041000&039000 section TownshIp40 Range 1 <br /> Original Description(or attach copy):.Lakeview Heights W 50' unsubdivided Pit BIk 4&Lot 1 <br /> fli <br /> current toainv RR1 1? plain WAN N Wks Yi is N takeativer Clan: 5' <br /> Fr Name of Water Body ath Shoreland Agreement/SIPS Y/N,;, <br /> i Farmland Preservation YIN:N Managed Forestry Law Y/N:N <br /> WV ParceiInfortttation ' <br /> Proposed New Legal Description and Parcel Size: CSM combine 2 existing lots <br /> Acres:. <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: tv <br /> 2 <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: '----- <br /> Date: 2,440. <br /> Signature of Owner. AO <br /> ".”,.. <br /> in <br /> Signature of Owner: ... Date: <br /> > Does parcel meet Zoning Requirements? Yes Aro0�j 2.____ R <br /> > Does parcel require a Survey? )es No <br /> 0° <br /> )> Permit application fees submitted? ❑ lmounl S.._.._ �(�..�.. Receipt 4 S <br /> r ® Y <br /> Reconciles with Real Property Lister es No Date: -7/e2.%/ f *4 <br /> a <br /> o <br /> o. <br /> If not,explain: l� <br /> . n Nt� <br /> a -, <br /> zm. v1 <br /> y <br /> Application: 'prove s Denied Reason for Denial. <br /> Land:- , .. .....:✓7 Zb Z/. . Date:, <br />