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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 54872 <br /> APPLICANT: OWNER: DARK Wipe io Tz <br /> Wagner Surveying Associates, Inc. <br /> 26745 Lakeland Avenue N. /4960 / AR-vir Se. Eke <br /> P.O. Box 8 <br /> Webster, Wisconsin 54893 A DoyE2 M,, 51zo9 <br /> 715-866-4295 <br /> PHONE: PHONE: <br /> ORIGINAL PARCEL OF INFORMATION: y� <br /> — LOCATION OF PROPERTY 6oy-f G, R <br /> d w •oNry L4'er <br /> — SECTION TOWN 10 RANGE / SIZE �� Ac <br /> — LEGAL DESCRIPTION �o{ CS/'� �./ 13 Py �j rd/�L /� 9—/Z 1�c r �� �•<���� <br /> CURRENT ZONING RIZI FLOODPLAIN (�/N �: WETLANDS Y/N <br /> NEW PARCEL INFORMATION: <br /> — LAND SURVEYOR PREPARING PLAT/MAP MARk l(myi <br /> — NUMBER OF LOTS Z PROPOSED ZONING S/►i�t <br /> — REGIONAL FLOOD ELEVATION iWHAlow.v <br /> LAIN l"< <br /> — WILL ACCESS TO NAVIGABLE BODY OF WATER BE PROVIDED/AVAILABLE Y/N <br /> — TYPE OF ACCESS (E8. OUTLOT, EASEMENT, ETC. ) <br /> — PROPOSED WATER AND SANITARY SYSTEM AfillAAe <br /> — PROPOSED USE: RESIDENTIAL _ COMMERCIAL OTHER <br /> DATE 7�Z2 f11 :_ SIGNATURE <br /> FEES COLLECTED: <br /> rn0u ;pyo ,fi� �1a Ole <br /> DATE OF LAND IISE COMMITTE /�E PRELIMINARY ACCEPTANCE ACTION <br /> DATE OF LAND USE COMMITTEE FINAL ACCEPTANCE ACTION <br />