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DATE <br /> PREAPPLICATION CONSULTATION FORM <br /> REQUEST FOR APPROVAL - SUBDIVISION <br /> BIJRNETT COUNTY LAND USE/ZONING DEPARTMENT <br /> BURNETT .COUNTY GOVERNMENT CENTER, SIREN, WI 54872 <br /> APPLICANT: OWNER: ey/tL JcnNJok <br /> Wagner Surveying Associates Inc C/6 Fs4l.w) <br /> luild nue <br /> P.O. Box 89 OANg&A t4jIj <br /> 11T910%,viloill 04 3 <br /> PHONE: <br /> 115-866.4295 PHONE: to Jt- 357 <br /> ORIGINAL PARCEL OF INFORMATION: <br /> - LOCATION OF PROPERTY S E Ski S<< /4 /�I EIIiIV St 2 3 <br /> — SECTION 23 TOWN ¢f RANGE SIZE /D <br /> — LEGAL DESCRIPTION Lo f 5 �'� Z C 1!►i V o l 16 4 117 <br /> - CURRENT ZONING C I FLOODPLAIN Y&,) WETLANDS Y/k) <br /> 'NEW PARCEL INFORMATION: <br /> - LAND 5URVEYOR PREPARING PLAT/MAP ph/lk <br /> - NUMBER OF LOTS 2 PROPOSED ZONING �i I <br /> — REGIONAL FLOOD ELEVATION .&4 <br /> — WILL ACCESS TO NAVIGABLE BODY OF WATER BE PROVIDED/AVAILABLE YC <br /> — TYPE OF ACCESS (EZ. OUTLOT, EASEMENT, ETC. ) <br /> — PROPOSED WATER AND SANITARY SYSTEM <br /> - PROPOSED USE: RESIDENTIAL COMMERCIAL _ OTHER <br /> DATE sh2l Vq SIGNATURE �v c <br /> FEES COLLECTED: - 1 <br /> DATE OF LAND USE COMMITTEE PRELIMINARY ACCEPTANCE50y/ `� ACTION <br /> DATE' OF LAND USE COMMITTEE FINAL ACCEPTANCE ACTION <br />