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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+$50.00/lot <br /> Owner: Mary Mastel B wner James Hughes .{ 2° ' ?Rt► ti iti1t t• ; <br /> 45 <br /> Address:8430 Pennsylvania Rd Apt 108Address: 649 Brockton Curve B <br /> Bloomington MN 55438 Eagan MN 55123 0 <br /> G4 <br /> 612-723-5013 651-343-1679 C... <br /> Phone: Phone: @a <br /> Original Parcel Information <br /> 07-012x40.15-07-5 05-003-031000,07-012-2-40-15-07-5 05-003-030000,07-012-2-40-15.07-5 05-004-011000 4.- <br /> Parcel ID#: Section 07 Township 40N Range <br /> 0 <br /> Pc!Gov Lot 3&Gov Lot 4 <br /> Original Description(or attach copy): a <br /> z <br /> .a Current Zoning: RR1 Floodplain Y/N: Y Wetlands YIN: N Lake/River Class: a„..,... <br /> •o <br /> a Name of Water Body: Ham Lake Shoreland Agreement/SIPS Y/N: <br /> 0 <br /> Farmland Preservation Y/N: N Managed Forestry Law YIN:N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: CSM changing lot lines on 2 existing parcels1_,t <br /> U <br /> Acres:6.61(If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: C <br /> a <br /> n <br /> Proposed access to public waters to be provided YIN: � <br /> If yes,describe access: <br /> Signature of Owner: Date: <br /> . <br /> Signature of Owner .it (< .t: - - Date: 4-1 _ o <br /> a <br /> •v <br /> > Does parcel meet Zoning Requirements? Yes No ' e <br /> 0 > Does parcel require a Survey? Yes No <br /> rz' 019 <br /> .90 <br /> 0° )=- Permit application fees submitted? 0 Amount$ /v 191 Receipt# <br /> t" ❑Reconciles with Real Property Lister Yes No Date: V\ <br /> m O <br /> If not,explain: <br /> 45 <br /> n <br /> 0 <br /> O.00 <br /> y <br /> Applicatio•. Approve. Denied Reason for Denial: <br /> Land Use: 9/2K2-.02-, Date: <br />