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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: Wagner Surveying Associates, Inc. Owner: /h1jteLYS 5lM1ho,5 -- i, g4iCe <br /> 11. <br /> P.O. Box 89 <br /> 165Y7 0� Blvd //ayayaGUE771" <br /> 74z15 866-4295 /"K , G� 9dl-6y <br /> �a„ <br /> �v � <br /> Al <br /> Phone: Phone: 6/9Y5-6-8 9 <br /> Original Parcel Information: ^� <br /> ➢ Location of Property: ./ n1 a 4 A rIA LAAej CA131'.' 166 <br /> ➢ Section: _2Y Township: Yl A/t Range: 15 tze: I�� " U7 <br /> O <br /> ➢ Legal Description: 1 ? '1 EXW3 , Aw.,&,W <br /> ➢ Current Zoning: Floodplait(gN.• WetlandsmN: <br /> New Parcel Information: <br /> ➢ Land Surveyor Preparing Plat/Map: awe/c- C IrAi� SiE <br /> ➢ Number of Lots: Proposed Zoning: .s/ 1h< <br /> ➢ Regional Flood Elevation: VAI f'(illonVP <br /> ➢ Will Access to Navigable Body of Water be Provided/Available, <br /> ➢ Type of Access (Example: Outlot, Easement, Etc): LAA-cL,f <br /> ➢ Proposed Water and Sanitary System: PA ll/A f t <br /> ➢ Proposed Use: Residential: _ Commercial: Other: <br /> Date: 9` 9- d l Signature: G�%�Q•t/i. 0V <br /> For Office Use Only — Fees Collected: <br /> Date of Land Use Committee Preliminary Acceptance: a c/.() Action: <br /> Date of Land Use Committee Final Acceptance: Action: <br />