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I. Burnett County Subdivision Permit Application Fees(must accompany form): <br /> Form or MapReview Form Subdivision w/o Survey: $50.00 <br /> and/or Pre-Application <br /> Survey of Existing Parcel: $50.00/►ot <br /> Subdivision w'Survey: S200.00+$50.00/lot <br /> Emanuel Gaziano Owner: Buyer: Edward F. Brinig <br /> Address: 4511 Fremont Ave. S. Address: 5948 Regent Ave. <br /> Minneapolis, MN Crystal, MN 55429 <br /> 612-730-1181 612-221-1457 <br /> Phone: Phone: <br /> Original Parcel Information w <br /> Parcel ID#: 07-038-2-41-14-0 i 5 05-003-012200 Section 3 Township 41 Range 14 <br /> Original Description(or attach copy): Lot 2 CSM No. 4962 <br /> In iD.v. lot '3, <br /> RR--f ��. f� <br /> Current Zoning: ' Floodplain Y/N: N Wetlands YIN: s`' Lake/River Class: ,hV <br /> -a Name of Water Body: Shoreland Agreement/S1PS YIN; N ("\ <br /> x Farmland Preservation YIN: Managed Forestry Law YIN: tD <br /> r <br /> New Parcel Information • <br /> Proposed New Legal Description and Parcel Size: A new CSM will divide the existing Lot 2 <br /> into two lots. <br /> Acres: 4.70 & 4.51 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: Direct Access to S.Adams Lake RoadI <br /> Proposed access to public waters to be provided Y/N: N <br /> If yes, describe access: p\ <br /> r- <br /> Jt nature or owner: .2f, vale: &p/ 0/2_ -2 <br /> ➢ Does parcel meet Zoning Requirements? Yes No i 00/6 V 7 <br /> r Does parcel require a Survey? Yes No <br /> , ➢ Permit application fees submitted? 0 Amount$ `3DQ,�� Receipt# <br /> CZ <br /> 0 Reconciles with Real Property Lister Yes No Date: V\ <br /> N <br /> If not, explain: <br /> Applicatio . • pprove ened Reason for Denial: <br /> Land L1se: #10111V "" Dat4 ��//40 c3 <br />