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iiq <br />Burnett County Subdivision Permit Application <br />Fees (must accompany form): <br />and/or Pre -Application Form or Map Review Form <br />Subdivision w/o Survey: $50.00 <br />Survey of Existing Parcel: $50.00/lot <br />Subdivision w/ Survev: 8200.00 + S50.00/lot <br />Owner: <br />Bradley & Pamela Anderson <br />Buyer: <br />Address: 3600 Prestige Lane Address: <br />Minnetonka, MN 55305 <br />Phone: <br />Parcel ID #: <br />Phone: <br />Original Parcel Information <br />036910002400 Section 36 Township 40 Range 17 <br />Original Description (or attach copy): Parcel described in Document No. 441178, <br />Lots 19-22, Block 1, The Pines, located in <br />Government Lot 4, Section 36, T40N, R1 7W <br />Current Zoning: RR -1 Floodplain Y/N:_N_Wetlands Y/N: i`'� Lake/River Class: <br />Name of Water Body: Yellow Lake Shoreland Agreement/SIPS Y/N: N <br />Farmland Preservation Y/N: N Managed Forestry Law Y/N: <br />New Parcel Information w7 a& , I_�3q—'� <br />Proposed New Legal Description and Parcel Size: This is CSM will be used to merge <br />4 lots into 1 lot <br />Acres: 0.82 ± <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 Pines End Road. <br />Proposed access to public waters to be provided Y/N: N <br />If yes, describe access: <br />Signature of Owner: N/A Date: <br />Nignature of uwner: tuate: <br />➢ Does parcel meet Zoning Requirements? Yes No <br />➢ Does parcel require a Survey? Yes No <br />Permit application fees submitted? Amount $s Receipt # <br />❑ Reconciles with Real Property Lister Yes No Date: <br />If not, explain: <br />Application: Approve / Denied Reason for Denial: <br />Land Use: Date: <br />W. <br />