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DATE <br /> PREAPPLICATION CONSULTATION FORM <br /> REQUEST FOR APPROVAL - SUBDIVISION <br /> BURNETT COUNTY LANs) USE/ZONING DEPARTMENT <br /> BURNETT COUNTY GOVERNMENT CENTER, SIREN, WI 54572 <br /> APPLICANT: t �( /II1Ih C7/L6NGWNER: <br /> mates, Inc. <br /> bRt 26745 Lakeland Avenue N. <br /> �yW/ b>fe_ hrS• Webster, Wisconsin 54893 <br /> PHONE: D l'/� -�22a PHONE: <br /> ORIGINAL PARCEL OF INFORMATION: <br /> - LOCATION OF PR'O/PERTY ,,/ <br /> - SECTION �i TOWN �0 RANGE Gl) SIZE <br /> - LEGAL DESCRIPTION <br /> - CURRENT ZONING L- Z FLOODPLAIN Y WETLANDS(�f/N <br /> NEW PARCEL INFORMATION: <br /> - LAND SURVEYOR PREPARING PLAT/MAP <br /> - NUMBER OF LOTS 3 PROPOSED <br /> n�zmaNG S41h6 <br /> - REGIONAL FLOOD ELEVATION /yM <br /> - WILL ACCESS TO NAVIGABLE BODY OF WATER BE PROVIDED/AVAILABLE Y/fid_ <br /> - TYPE OF ACCESS (ES. OUTLOT, EASEMENT, ETC- ) 1 - <br /> - PROPOSED HATER AND SANITARY SYSTEM 70/2It/T/ <br /> - PROPOSED USE: RESIDENTIAL COMMERCIAL OTHER <br /> DATE r ( SIGNATURE 4 <br /> FEES COLLECTED: <br /> DATE OF LAND USE COMMITTEE PRELIMINARY ACCEPTANCE ACTION <br /> DATE, OF LAND USE COMMITTEE FINAL ACCEPTANCE ACTION <br />