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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: bVi4ttiJER .SGtt2t/E 'AzG Owner: 1AAA1,,04 '65!4,Q5� Aj <br /> o. BoX 8 9 X37.5 <br /> ,9�r,Vr' 7 <br /> !i✓E8S'TE,P. w/ 0.4,x ., /YJ�/. 5��8 <br /> Phone: �� — g2`jS Phone e6S/— 77p— `—?/7 <br /> Original Parcel Information: <br /> ➢ Location of Property: � x_. / <br /> ➢ Section: / �' Township:7--f-/Al Range:/5-" Size: /9 . <br /> ➢ Legal Descriptio5.45X. ;2-?-f <br /> ok 7 <br /> ➢ Current Zo ng: Floodplain Y/N.• ._ / Wetlands Y/N.• <br /> New Parcel Information: <br /> ➢ Land Surveyor Preparing Plat/Map: <br /> ➢ Number ofLots: Proposed Zoning: <br /> ➢ Regional Flood Elevation: <br /> ➢ Will Access to Navigable Body of Water be Provided/Available, YIN: <br /> ➢ Type of Access (Example: Outlot, Easement, Etc): <br /> ➢ Proposed Water and Sanitary System: <br /> ➢ Proposed Use: Residential: Commercial: Other: <br /> Date: 3/�2 Q Signature: _ <br /> For Office Use Only — Fees Collected: <br /> Date of Land Use Committee Preliminary Acceptance: f �3 -- Action: plyxd <br /> Date of Land Use Committee Final Acceptance: Action: <br />