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Fees (must accompany fonn): <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 vv/ Snrvev: $200.00+$50.00/lot <br />Owner:Ailaq Bang$, Buyer: <br />Address: S� YA C )a1,e kcL,.zn Ave- Address: <br />Phone: <br />Ec��r MN 55143H <br />Phone: <br />Original Parcel Information <br />Parcel ID #: o7.G3�-o�- y I - ltp- .3(n -5 f),C_ 61-,f _C)Ig, ccs Section,3(D_Townshi� 91 Range�� <br />Original Description (or attach copy): _ 'PC L t] o Li:-.)-- 1 <br />01- <br />Current <br />i <br />Current Zoning: FSKA FloodplaiY i Wetlands Y� Lake/River Class: <br />Name of Water Body: t� i �Ezc�re "'Z_ Shoreland Agreement/SIPS Y/N: <br />Farmland Preservation `�: Managed Forestry Law li(N �o <br />New Parcel Information <br />Proposed New Legal Description and Parcel Size: _0 c-4 A,1 I Lo - C c:� <br />Acres: 3, tp <br />(If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Proposed access to public road: <br />C <br />n <br />Proposed access to public waters to be provided Y/v: <br />J <br />If yes, describe access: <br />W <br />i <br />07/20/2018 <br />Sti <br />�meilaur=� <br />Signature of Owner: SIGNED` Date: 06:15 PM CDT <br />p <br />o0 <br />Signature of Owner: Date: <br />o <br />B <br />z <br />➢ Does parcel meet Zoning Requirements? Yes tVo 7 /Z-7 18" <br />e <br />L /8' 3 <br />➢ Does parcel require a Survey? Yes eVo L/'� <br />0° <br />i Permit application fees submitted? ❑ Amount $ Receipt # <br />t, <br />❑ Reconciles with Real Property Lister Yes No Date: <br />If not, explain: <br />7J <br />r, <br />r <br />0 <br />c <br />y <br />Application: Approved / enied Reason for Denial: <br />Land Use: 3� �� Date: <br />