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DATE <br /> PREAPPLICATION CONSULTATION FORM <br /> REQUEST FOR APPROVAL - SUBDIVISION <br /> BURNETT COUNTY LAND USE/ZONING DEPAR1 3IENT <br /> BURNETT COUNTY GOVERNMENT CEIV M, SIREN, WI 54572 <br /> APPLICANT: XGiVE -5"<1�p✓ /✓V(�owxER;, rf�c'f�,�IE� l�iE'i� Z,4Ah) <br /> py <br /> PHONE: PHONE: <br /> ORIGINAL. PARCEL OF INFORMATION: EX/_!�plvG <br /> - LOCATION OF PROPERTY/V � /LI//✓� 5 �. .s . T-3 'N—Q�/ Le/ <br /> - SECTION TOWN--5 & RANGE SIZE u 7 <br /> - LEGAL DESCRIPTIO %� -/UL /1/� Oi� S/•C(/e LK 1� <br /> CURRENT Z G I FLOODPLAIN Y/N N WETLANDS Y/N ,/V <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 Y/N .N <br /> - TYPE OF ACCESS (EZ. OUTLOT, EASEMENT, ETC. ) <br /> - PROPOSED WATER AND SANITARY SYSTEM /�/�✓ E �X/$7/f'✓ G <br /> - PROPOSED USE: RESIDENTIAL -)<' _ COMMERCIAL. OTHER <br /> DATE i- SIGNATURE <br /> L ' <br /> FEES COLLECTED: <br /> DATE OF LAND USE COMMITTEE PRELIMINARY ACCEPTANCE ACTION y <br /> DATE- OF LAND USE COMMITTEE FINAL ACCEPTANCE ACTION <br />