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PREAPPLICATION CONSULTATION FORM <br /> REQUEST FOR APPROVAL - SUBDIVOON <br /> BIJRNETT COUNTY LAND USEIZONING DEPARTMENT <br /> BUR1NETT COUNTY GOVERNMENT CENTER, SIREN, WI 54572 <br /> Ae'"PLIC�.NT: OWNER: ��.!:' ani AMC:.S /'YJA21�E(Z <br /> Wagner Surveying Associates, Inc. C/o CEwcyP.� Z1 <br /> 26745 L � <br /> akeland Auawle <br /> P.O. Bok 89 <br /> a( balor lAl6SCQ0S6n 5a$gg <br /> 715-866-4295 3S � <br /> PcO;,�; PHONE: <br /> ORZ3= PAZCM OF =700 �lTION: <br /> — LOCATION OF PROPERTY <br /> SECTION TOWN L (D RANGE t y SIZE 40- <br /> - <br /> C— LEGAL DESCRIPTION <br /> — CURRENT ZCNIgG FLOODPLAIN Y WETLANDS Y4E) _ <br /> NEW PARC. Ia1FORNATION: n <br /> — LAND SURVEYOR PREPARING PLAT/MAP 1724R-KC- k` f �EISE„ <br /> — NUMBER OF LOTS 3--PROPOSED ZOrr=G S Q m <br /> — REGIONAL FLOOD ELEVATION /tj/4 <br /> — WILL ACCESS TO NAVIGABLE BODY OF WATER BE PROVIDED/AVAILABLE Y <br /> — TYPE OF ACCESS (EZ. OUTLOT, EASEMENT, ETC. ) <br /> — PROPOSED WATER AND SANITARY SYSTEM' <br /> - PROPOSED USE: RESIDENTIAL �_ COMMERCIAL OTHER <br /> DAT? X113 g SIGNATURE <br /> FEES COLLECTED: <br /> DATE OF LAND USE COMMITTEE PRELIMINARY ACCEPTANCE 146-, ACTION` <br /> DATM OF LAND USE COMMITTEE FINAL ACCEPTANCE ACTION <br />