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Pre-application Consultation Form <br /> Request For Approval— Subdivision J <br /> Burnett County Land Use/Zoning Department <br /> Burnett County Government Center; Siren, Wisconsin <br /> Applicant: Owner:�� �•4 v�Su,✓/ci�A�3�T,� <br /> SWE / <br /> 25070 State Road 35S�acJ <br /> c AC P.4ce-S 0 <br /> $iron. 648 <br /> /g37!�o <br /> Phone: .3¢9 S z6 Phone: f-63 0-17 9 <br /> N <br /> Original Parcel Information: <br /> ➢ Location of Property: S'C''/f_ Al <br /> / <br /> ➢ Section: 33 Township: 39 Range: /9 W Size: /e <br /> ➢ Legal Description: 1967,2W A4 2 n3s' / ^ 1 <br /> ➢ Current Zoning: 6 fl Floodplain YIN: Al Wetlands YIN: N to � ` A <br /> New Parcel Information: <br /> ➢ Land Surveyor Preparing Plat/Map: 7;kb wiy j JW6U/f0,J <br /> ➢ Number of Lots: Z Proposed Zoning: AIIA- <br /> ➢ Regional Flood Elevation: ��Jg <br /> ➢ Will Access to Navigable Body of Water be Provided/Available, YIN: N <br /> ➢ Type of Access (Example: Outlot, Easement, Etc): ToAlAf /20 <br /> ➢ Proposed Water and Sanitary System ®/li di►Tc <br /> ➢ Proposed Use: Residential: _ Commercial: Other: <br /> Date: 'z6=/_z 003 Signature: !�f a n JZ�f�- <br /> For Office Use Only — Fees Collected: <br /> Date of Land Use Committee Preliminary Acceptance. 4 Action: <br /> Date of Land Use Committee Final Acceptance: Action: <br />