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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: Owner: Ge50P,(C- <br /> c ' <br /> rf`�r r+"r ... ..,..J �i�rl�✓L�F-«/ /i <br /> Phone: Phone: 3.2o <br /> Original Parcel Information: <br /> ➢ Location of Property: S �r SV v <br /> ➢ Section: 4 Township: 40/x1 Range: 146 CA/ Size: -©/AC- Y"" <br /> ➢ Legal Description: ,,�A40!5- <br /> ➢ Current Zoning: /` _'�Voodplain YIN: r Wetlands Y/N.• _ Y <br /> New Parcel Information: <br /> ➢ Land Surveyor Preparing Plat/Map: <br /> ➢ Number of Lots: Proposed Zoning: <br /> ➢ Regional Flood Elevation: �/\//�/yCaLl/1✓ <br /> ➢ Will Access to Navigable Body of Water be Provided/Available, Y/N.• _-L —�.S fAtl) <br /> ➢ Type of Access (Example: Outlot, Easement, Etc): /C oT _!�_ 11� ri�o/�77s4C,E <br /> ➢ Proposed Water and Sanitary System: �/e/✓4Ti:5 <br /> ➢ Proposed Use: Residential: _)<0" Commercial: Other: <br /> Date: 2 D Signature: <br /> For Office Use Only — Fees Collected: ?�j <br /> Date of Land Use Committee Preliminary Acceptance: d Action: ✓2�/C ` <br /> Date of Land Use Committee Final Acceptance: O A ti n: o �� <br />