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Pre-application Consultation Form <br /> Request For Approval — Subdivision <br /> Burnett County Land Use/Zoning Department <br /> Burnett County Government Center; Siren, Wisconsin <br /> Applicant: Wagner Surveying Associates, ncOwner: U l°(�`C 1-f"/✓p <br /> . <br /> 26745 Lakeland Avenue N. ro /1,61 lqf <br /> Box 89 <br /> Webster Wisconsin 54893 S/? Crh f'r, /nn•.S"��78 <br /> 715-866-429b <br /> Phone: Phone: <br /> Original Parcel Information: <br /> ➢ Location ofProperty: Doc K 0499 (LDAP <br /> ➢ Section: /V Township: Range: I V"l Size: <br /> ➢ Legal Description- /V ty�>(y 11/VV <br /> ➢ Current Zo ng: Floodplain Y0 Wetlands Y& <br /> New Parcel Information: �y, <br /> ➢ Land Surveyor Preparing Plat/Map: Mate e jad-a 5 E <br /> ➢ Number of Lots: 7 Proposed Zoning: SSf A c KR? <br /> ➢ Regional Flood Elevation: IVA <br /> ➢ Will Access to Navigable Body of Water be Provided/Available, Y9 <br /> ➢ Type of Access (Example: Outlot, Easement, Etc.): <br /> ➢ Proposed Water and Sanitary System: Pei&'tif< <br /> ➢ Proposed Use: Residential: Commercial: Other: <br /> Date: 2 - U Signature: y? <br /> For Office Use Only — Fees Collected: <br /> Date of Land Use Committee Preliminary Acceptance. Action: <br /> Date of Land Use Committee Final Acceptance: Action: <br />