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PREAPPLICA17ION CONSULTATION FORM <br /> REQUEST FOR APPROVAL - SUBDIVISION <br /> BUJRNETT COUNTY LAND USE/ZONING DEPAR111ENT <br /> BURNETT COUNTY GOVERNMENT CENTER, SIREN, WI 54572 <br /> Ar"PLICM'i': 1/�/iL7�ti/ �' S�.l.2UEYr✓v OWNER:oRU�v Cc»,c,�iNs�sT.a.vr S�boR�07)r <br /> /�✓��ST�,P. IN/' `� S ' 2, WX -5�488t-' <br /> PHONY: "0 4 2.c7-5— PHONE: <br /> OR2GLlAL PARCEL OF nTFORMATION: <br /> - LOCATION OF PROPERTY O U� ��� �o f 7 <br /> - SECTION 3� TOWN Q RANGE /� SIZE <br /> — LEGAL DESCRIPTION G 4 7 eEx, z—c>7-5- /— `f C,s,/4. 1/ <br /> - CIIRBENT ZONING R/e I FLOODPLAIN Y/N- I-A E WETLANDS YIN ✓� <br /> NEW PARCEL INFORMATION: <br /> - LAND SURVEYOR PREPARING PLAT/MAP <br /> - NEER OF LOTS / PROPOSED ZONING 5 � <br /> - REGIONAL FLOOD ELEVATION y�S <br /> - WILL ACCESS TO NAVIGABLE BODY OF WATER BE PROVIDED/AVAILABLE Y/N�y_ <br /> - TYPE OF ACCESS (EZ. OUTLOTo EASEMENT, ETC. ) <br /> - PROPOSED WATER AND SANITARY SYSTEM' <br /> - PROPOSED USE: RESIDENTIAL �.. COMMERCIAL OTHER <br /> DAT$—zz� J 8 SIGNATURE <br /> FEES COLLECTED: <br /> DATE OF LAND USE COMMITTEE PRELIMINARY ACCEPTANCE ACTION <br /> DATR OF LAND IISE COMMITTEE FINAL ACCEPTANCE ACTION <br />