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Pre-application Consultation Form <br /> Request For Approval— Subdivision <br /> Burne t County Land Use/Zoning Department <br /> Burnett County Government Center; Siren, Wisconsin <br /> Wagner Sur eying Associates, Inc. <br /> Applicant Owner Elit —pri:�-t <br /> K0. sox 89 <br /> Wehatar. Wisconsin 54893 <br /> 7 6-866-4296 E J/c.p h W r J <br /> Phone: Phone: <br /> Original Parcel Informati n: <br /> ➢ Location of Property: E X112 S C S E <br /> ➢ Section: 35 Township: 39A/ Range: Size: Z0 <br /> ➢ Legal Description: 5E Iy 5 2� <br /> ➢ Current Zoning: VN 2-Neo( Floodplain Y6 Wetlands Y <br /> New Parcel Information: <br /> ➢ Land Surveyor Prepari g Plat/Map: <br /> ➢ Number of Lots: '3 Proposed Zoning: S Ali"K <br /> ➢ Regional Flood Elevation: — <br /> ➢ Will Access to Navigable Body of Water be Provided/Available, Y N <br /> ➢ Type of Access (Example: Outlot, Easement, Etc): <br /> ➢ Proposed Water and Sanitary System: Pr'Ujt <br /> ➢ Proposed Use: Residential: V1, Commercial: Other: <br /> Date: 9'6"69-� Signature: .� <br /> For Office Use Only Fees Collected: <br /> Date of Land Use Com ittee Preliminary Acceptance: — — Action: cqAp c� <br /> IT- <br /> Date of Land Use Com ittee Final Acceptance: Action: <br />