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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: (�o �{ o e Owner:-. <br /> Tfo.VlS d' m��c�¢`e. ra.y•er �o,l/e. s^ <br /> Phone: -7� S - (OS G - -70 -l '), Phone: <br /> Original Parcel Information: <br /> ➢ Location of Property: N W '4 5 V <br /> ➢ Section: la Township: Range: Size: <br /> ➢ Legal Description: �DOC Lkv"e-v�-� 1�0 ZGS Pj(a q <br /> ➢ Current Zoning: 2 Floodplain YIN. � Wetlands YIN.- <br /> OY1 (�(oPe��V <br /> New Parcel Information: �Q <br /> ➢ Land Surveyor Preparing Plat/Map: J \ O n) (A l-D IAO F F M A,N P� <br /> ➢ Number of Lots: 11), Proposed Zoning: R 2- <br /> > <br /> ➢ Regional Flood Elevation: 0/A <br /> ➢ Will Access to Navigable Body of Water be Provided/Available, YIN.• <br /> ➢ Type of Access(Example: Outlot, Easement, Etc): S� . Liy <br /> ➢ Proposed Water and Sanitary System: 'pf't V a to <br /> ➢ Proposed Use: Residential: X Commercial: Other: <br /> Date: a a00 Signature: Agent _ 1 <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 />