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DATE <br /> PREAPPLICATION CONSULTATION FORM <br /> REQUEST FOR APPROVAL - SUBDIVISION <br /> BURNETT COUNTY LAND USE/ZONING DEPARTMENT <br /> BURNETT COUNTY GOVERNMENT CENTER, SIREN, WI 54572 <br /> APPLICANT: <br /> OWNER: KCh 1>40p, <br /> Wagner Surveying Associates, Inc. xgl?q E. p,,-f•,- TA#e. <br /> 26746 �81(81@md Avent N' <br /> P.O. Box 89 S-irzeh bor. <br /> 11 54893 <br /> ?HONE: 715-866-4295 PONE: 6S6 - 32g2 3¢q.3'7,7f <br /> ORIGINAL. PARCEL OF INFORMATION: <br /> LOCATION OF PROPERTY kW NE f NE NW <br /> SECTION 23 TOWN RANGE �G SIZE o A <br /> LEGAL DESCRIPTION -- <br /> CURRENT ZONING__L9 r 2 FLOODPLAIDI YA�f) WETLANDS YXV <br /> dCi F.. NENw <br /> NEW PARCEL INFORMATION: <br /> - LAND SURVEYOR PREPARING PLAT/MAP dause <br /> - NUMBER OF LOTS 4 PROPOSED ZONING SAAC (XfZ) <br /> - REGIONAL. FLOOD ELEVATION <br /> - WILL ACCESS TO NAVIGABLE BODY OF WATER BE PROVIDED/AVAILABLE <br /> - TYPE OF ACCESS (ES. OUTLOT, EASEMENT, ETC- ) <br /> - PROPOSED WATER AND SANITARY SYSTEM PiG✓hT-e <br /> - PROPOSED USE: RESIDENTIAL k COMMERCIAL OTHER <br /> DATE S/4 1 q p SIGNATURE Y a, <br /> FEES COLLECTED: s4S <br /> DATE OF LAND USE COMMITTEE PRELIMINARY ACCEPTANCE ACTION <br /> DATE• OF LAND USE COMMITTEE FINAL ACCEPTANCE ACTION <br />