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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+$50.00/lot <br /> Owner <br /> Owner: Scott Theis Trust KBliWaren Theis <br /> ot <br /> co <br /> Address: 813 Ivywood Circle N Address: 813 Ivywood Circle N g <br /> Lake Elmo MN 55042 Lake Elmo MN 55042 / o <br /> Phone: /. 09 —0�8 � Phone: 51 —.7� /—7CO 7 , <br /> Original Parcel Information p <br /> 07-018-2-39-16-24-5 05-002-015002 <br /> Parcel ID#: 07-018-2-39-16-24-5 05-002-015100 Section 24 Township 39N Range 16W <br /> 39-Ib-a3-5 65-DO4-aQo?OOO 0 <br /> Original Description(or attach copy): w ion'of GI 9& I nt 9 CSM#1R94 V9 P58&that part of Nw-SW a <br /> lying N of Town Rd :? <br /> f . <br /> Current Zoning: RR2 Floodplain Y/N: Y Wetlands Y/N: N Lake/River Class: <br /> ia Name of Water Body: Bass Lake Shoreland Agreement/SIPS YIN; / I Nr <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N: N 'v\P ---k <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: 2 Lot CSM 3 LA cSIY1 <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: d <br /> a <br /> Proposed access to public waters to be provided Y/N: ••G <br /> \ <br /> If yes,describe access: ,- . <br /> • <br /> Signature of Owner: .o -" — !-- <br /> CC Date: ��-o,02 2 <br /> .. N <br /> Signature of Owner: Date: �J— —�g� o <br /> v <br /> > Does parcel meet Zoning Requirements? Yes No L A-6.0�6 7 <br /> N > Does parcel require a Survey? Yes No " <br /> 0 <br /> d <br /> cm ➢ Permit application fees submitted? 0 Amount$ 3-9 Receipt# <br /> G.) <br /> a ® Reconciles with Real Property Lister No Date: ill-13-aa. <br /> a 4 <br /> Q. 1 <br /> If not,explain: 1 <br /> e <br /> o <br /> .9 <br /> 0. <br /> cA <br /> wW <br /> W <br /> Application- • pproved Denied Reason for Denial: 01 <br /> Land Use: /0 // 7,QZ Z Date: <br />