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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: Wager 1.,.-,dates, Mic. Owner:.11Q �I111�� � . Q�l•/�� <br /> Phone: Phone: 116- 656 - -7() y y <br /> Original Parcel Information: <br /> ➢ Location of Property: G• L 2 ,/ <br /> ➢ Section: 19 Township: l I N Range: 15 kASize: 4,a4 <br /> ➢ Legal Description: Ex_ j n7 E. 2J8 o F We,l 6S$ t <br /> ➢ Current ZoninFloodplain®N: Wetland <br /> New Parcel Information: <br /> ➢ Land Surveyor Preparing Plat/Map: fel a rK E Krcw s <br /> ➢ Number of Lots: Proposed Zoning: <br /> ➢ Regional Flood Elevation: NA <br /> ➢ Will Access to Navigable Body of Water be Provided/Available, YW: L-4 KC L-4 <br /> ➢ Type of Access (Example: Outlot, Easement, Etc): <br /> ➢ Proposed Water and Sanitary System: pe, iy 44 t Ck^s f,y-d' <br /> ➢ Proposed Use: Residential: A — Commercial: Other: <br /> Date: I ` ID O 2 Signature: <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 />