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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: �olnGLl 60A_.1 Owner: M }2" oa( CooL <br /> 6,(:,> ,lam, /zr,) S(yo s�rg 2cA D �7 <br /> Phone: �j — Phone: �j 7-370 <br /> Original Parcel Information: <br /> ➢ Location of Property: 5FR. -SE <br /> /¢- <br /> ➢ Section: /cl Township: Range: Size: `- 1__ <br /> ➢ Legal Description: - 33O X((00 y CS <br /> ➢ Current Zoning: - Floodplain "C"/ N Wetlands YIN.- <br /> New Parcel Information: <br /> ➢ Land Surveyor Preparing Plat/Map: I c)lnG l <br /> ➢ Number of Lots: Proposed Zoning: .10 G <br /> ➢ Regional Flood Elevation: A} <br /> ➢ Will Access to Navigable Body of Water be Provided/Available, YIN.- N <br /> ➢ Type of Access (Example: Outlot, Easement, Etc): <br /> ➢ Proposed Water and Sanitary System: fyr — <br /> ➢ Proposed Use: Residential: _2_ Commercial: Other: <br /> (:4Date: Z bZ Signature: <br /> ecQ S4cm4v- 2t L <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 />