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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 WI Survey: $200.00+$50.00/lot <br /> Owner:7474 Ranch LLC-Valentin Shargorodskiy Buyer: <br /> A <br /> Address: 11260 Hidden Oaks Crt Address: g' <br /> Champlin MN 55316 `ti) <br /> C. <br /> Phone: Phone: <br /> Original Parcel Information <br /> 07.130-2381617 <br /> - - - -5 Section 17 Township38N Range 16W mParcel ID#l: e <br /> Original Description(or attach copy): Forgotten Tymes Lot 3 GL A <br /> p� <br /> to 4 <br /> sk.� Current Zoning: RR1 Floodplain Y/N: Y Wetlands Y/N: N Lake/River Class:_ ��. <br /> m Long Lake <br /> NameoBody: rAgreement/SIPS <br /> 0 <br /> .. Farmland Preservation Y/N: N Managed Forestry Law Y/N: N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: ct <br /> LA <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: d <br /> i; <br /> Proposed access to public waters to be provided YIN: <br /> If yes,describe access: <br /> r <br /> Signature of Owner: 1 'e 'r" Date: ///01 /.2( d <br /> n <br /> Signature of Owner: Date: ° <br /> a <br /> > Does parcel meet Zoning Requirements? Yes No „L 60.5-02.- '9 <br /> ., <br /> N <br /> ➢ Does parcel require a Survey? Yes No W <br /> Sop vl <br /> Recei t it <br /> 00 D Permit application fees submitted? Amount$ P 1 <br /> lv <br /> r13,Reconciles with Real Property Lister es No Date: ‘2..-1 O - Z.1 UI <br /> m <br /> 0 <br /> If not,explain: <br /> m <br /> ij <br /> el <br /> 0 <br /> a <br /> ApplicatipA proved ailed Reason for Denial: <br /> Land Use: / /�0 ZIPZI Date: <br />