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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/ Survev: $200.00 + $50.00/lot <br />Owner: Patrick A. Maxwell & Chalah I Buyer: Jonathon Williamson <br />Mosay P.O. Box 434 <br />Address: Address <br />Webster, WI 54893 <br />715-220-1892 <br />4017 Boardman St. <br />Minneapolis, MN 55417 <br />651-214-7956 <br />Phone: Phone: <br />Original Parcel Information <br />Parcel ID #:07-018-2-39-16-33-1 01-000-011000 Section 33 Township 39 Range 16 W <br />Original Description (or attach copy): The Northeast Quarter of the Northeast Quarter <br />(NE 1/4 NE 1/4), Section Thirty-three (33), Township Thirty-nine (39) North. <br />Range Sixteen (16) West, Burnett Countv, Wisconsin <br />Current Zoning: RR2 Floodplain Y/N: NO Wetlands Y/N: NO Lake/River Class: N/A <br />Name of Water Body: N/A Shoreland Agreement/SIPS Y/N: NO <br />Farmland Preservation Y/N: NO Managed Forestry Law Y/N: NO <br />New Parcel Information <br />Proposed New Legal Description and Parcel Size: SEE ATTACHED RIDER FOR LEGAL DESCRIPTIO <br />Acres: 10 <br />(If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Proposed access to public road: Located on Midtown Road <br />Proposed access to public waters to be provided Y/N: NO <br />If yes, describe access: <br />Signature of Owner: �,V�/i 4X ✓"' Date: - Z S-- / 7 <br />i Ma wel <br />Signature of Owner. Date: 3 - Z s- -! y <br />Chalah I Mncav <br />➢ Does parcel meet Zoning Requirements? <br />➢ Does parcel require a Survev? <br />➢ Permit application fees submitted? ❑ <br />Yes No <br />Yes No Amount $ `J(�� U -7 <br />Y eceipt # <br />❑ Reconciles with Real Property Lister Yes No Date: <br />If not, explain: <br />Ap <br />Land U <br />Denied Reason for Denial: <br />Date: 3/z8-/20/ <br />M <br />