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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> and/or Pre-Application Form Subdivision w/o Survey: $10.00 <br /> YY Subdivision w/Survey: S25.00+$5.00/lot <br /> i Owner: Jill Anne Ellison <br /> Address: c/o Benson Law Office <br /> P.O. Box 370, Siren, wI 54872 Phone: 715 349-5215 <br /> OrleInaI Parcel Information (2) <br /> 012-4216-02 500 <br /> Parcel Identification#: 012-4216-02 600 Section 16 Township 4ON Range 15w 3' <br /> Original Descr;p+tion (or attach copy): Gov. Lot 6 <br /> 0 <br /> q Current Zoning: Floodplain Y/N: Wetlands Y/N: o <br /> 9 Lake/River Classification: Middle Loon Lake <br /> m 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. <br /> 1) 40 acres <br /> Acres. 2) 31.4 acres <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 /> d <br /> If yes,describe access: A <br /> Q <br /> C <br /> ➢ Does parcel meet Zoning Requirements? Yes No � <br /> ➢ Does parcel require a Survey? Yes No n <br /> as o <br /> ➢ Permit application fees submitted? d Amount S Receipt # 12 <br /> C <br /> A <br /> e 13 Reconciles With Real Property Lister Yes No Date: cS o <br /> a <br /> eIf not, explain: _ <br /> a � <br /> y <br /> I � <br /> O b <br /> Appilcatio Appros ed / enied Reason for Denial: <br /> Oo <br /> Land Use Date: <br /> 2/18/2003 <br />