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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> and/or Pre-A lication Form Subdivision w/o Survey: $10.00 <br /> pp Subdivision w/Survey: S25.00+$5.00/lot <br /> Owner: Jill Anne Ellison <br /> Address: c/o Benson Law Office <br /> P.O. Box 370, Siren, WI 54872 Phone: 715 349-5215 <br /> Orieina)Parcel Information (2) ro <br /> 012-4216-02 500 <br /> Parcel Identification M 012-4216-02 600 Section 16Township 40N Range 15W 3' <br /> Original DescrRl;tion (or attach copy): Gov. Lot 6 <br /> 0 <br /> > Current Zoning: Floodplain Y/N: Wetlands Y/N: <br /> 9 Lake/River Classification: Middle Loon Lake <br /> Name of Water Body: Lower Loon Lake <br /> e <br /> New Parcel Information m <br /> Proposed New Legal Description and Parcel Size: (1) The South 1320 feet of Gov. Lot 6 <br /> (2) Gov. Lot 6 except the South 1320 feet thereof. k <br /> 1� e <br /> Acres: _)40 31.4acracsres <br /> Y� <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: private easement across Gov. Lot 3 to Co. Rd. C <br /> Proposed access to public waters to be provided Y/N: No <br /> m <br /> If yes, describe access: <br /> Q <br /> ➢ Does parcel meet Zoning Requirements? Yes No 0 <br /> ➢ Does parcel require a Survey? Yes No n <br /> 'a <br /> oa o <br /> ➢ Permit application fees submitted? d Amount$ Receipt # <br /> D <br /> r A <br /> b <br /> e l� Reconciles With Real Property Lister Yes No Date: b � <br /> a <br /> eIf not,explain: _ <br /> �' 9t <br /> cs <br /> O b <br /> Applicatio Appros ed / enied Reason for Denial: W a <br /> ooh <br /> Oo <br /> Land Use: Date: <br /> 2/18/2003 <br />