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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: Owner: <br /> L. cIaid I Pd. <br /> Vifte•ie2;' Mscorcin :77 <br /> 71'5-`u6b <br /> Phone: Phone: 3..2� <br /> Original Parcel Information: / <br /> ➢ Location of Property: 2=�_ � .4 <br /> ➢ Section: `T Township: 40/x✓ Range: /09 CAS Size: 30140. <br /> ➢ Legal Description: ,�it/d� ,L��!✓V�� <br /> ➢ Current Z Hing: /e 2Floodplain YIN. _ }� Wetlands YIN: <br /> New Parcel Information: <br /> ➢ Land Surveyor Preparing Plat/Map: <br /> ➢ Number of Lots: Proposed Zoning: <br /> ➢ Regional Flood Elevation: <br /> ➢ Will Access to Navigable Body of Water be Provided/Available, YIN.- f LAS aA1^y <br /> ➢ Type of Access (Example: Outlot, Easement, Etc): o—T S �7i� 1C';Eo1V_74CE <br /> ➢ Proposed Water and Sanitary System: JC�R/V'4 T6 <br /> ➢ Proposed Use: Residential: Commercial: Other: <br /> Date: _' o f Signature: zi'� <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 />