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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 /> ra <br /> b <br /> Owner: Timothy Kretzmann Trust Buyer: Washburn Family Revocable Trust A g <br /> Address:3391 46th Ave S Address: 10003 Olinger Rd m o <br /> Minneapolis MN 55406 Webster WI 54893 cn <br /> P <br /> Phone: Phone: Y' <br /> Original Parcel Information <br /> Tax ID#: 5682 &5633 section 25 Township 40 Range 15 <br /> O <br /> Original Desc 'ption(or attach copy):GL 1 & Lot 1 & OL 2 CSM V7 P229 N <br /> H <br /> • <br /> Current Zo ' g: RR1 Floodplain Y/N_Y Wetlands Y/N: N Lake/River Class: i <br /> Name of Wat Body:North Sand & Pine Lake Shoreland Agreement/SIPS Y/N: A <br /> cA <br /> Farmland Preservation Y/N:N Managed Forestry Law Y/N: N <br /> 0 <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: 2 lot CSM <br /> 1 <br /> y <br /> a <br /> Acres <br /> g <br /> H <br /> (If parcel is to e surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed ace to public road: C <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: / <br /> Signature of Owner: 9J 't----- Date: ////!,3C7o` <br /> Signature of Owner- L Date: lib- /zd 2c <br /> Does par l meet Zoning Requirements? Yes No Check#: <br /> Does par 1 require a Survey? Yes No Fee Rec: <br /> Reconciles with Real Property Lister Yes No Date: <br /> If not,explain: <br /> Application: Approved / Denied Reason for Denial- <br /> Land Use: Date: <br />