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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 or Map Review Form subdivision w/survey: $200.00+$50.00/lot <br /> b <br /> up <br /> va A <br /> Owner: Kraig A Niebuhr Trust Buyer: Douglas Kampsen Ai <br /> CJ <br /> Address:29978 Hayes Ave Address: 5104 Wild Marsh Dr i c <br /> Northfied MN 55057 White Bear Lake MN 55110 <br /> ND <br /> Phone: Phone: — <br /> Original Parcel Information <br /> Tax ID#: 07-038-2-41-14-28-5 05-001-021000 Section 28 Township 41 N enrage 14W ' --- C1i' <br /> V <br /> 07-038-2-41-14-28-5 05-001-020010 <br /> Original Description(or attach copy): Lot 1 CSM V3 P7 & Lot 1 CSM V26 P150 <br /> GL1 o <br /> ri <br /> Current Zoning: RR1 Floodplain YiN•N_Wetlands Y/N: N Lake/River Class: <br /> Des Moines Lake �, <br /> Name of Water Body: Shoreland Agreement/SIPS Y/N: � <br /> Farmland Preservation Y/N:N Managed Forestry Law Y/N: N "� <br /> New Parcel information <br /> t e <br /> Proposed New Legal Description and Parcel Size: 2 Lot CSM of existing lots31 <br /> �1 <br /> Acres'2.30 <br /> (if parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> Proposed access to public waters to be provided Y/N: <br /> k.) <br /> If yes,describe access: <br /> c��-s^'— / / / <br /> Signature of Owner: _41f ff ikv,- t _ Date: I—y�144' , <br /> Signature of Owner: Date:___.;zt L3 <br /> Fee Ree: /60, <br /> ➢ Does parcel meet Zoning Requirements? Yes No w, Check#:(v4 <br /> > Does parcel require a Survey? Yes No 1 <br /> a <br /> 5 <br /> Reconciles with Real Property Lister Yes No Date: g <br /> u, <br /> If not,explain: <br /> 0 <br /> Application: roved / D)nied Reason for Denial- Fl <br /> Land U •• — Date: <br /> � 9 Zozf/ i <br />