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a �aa� o6 <br /> 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: oK) .\A �O`{ rte,o�e,� Owner: <br /> aaa a3s�h ASE I60S 3 S <br /> � <br /> sooh G r an`��s b .�I . 54B $0Phone: 7 ( S - 8 S S Phone: 7`S - i-M�C� � � � <br /> Original Parcel Information: c , • / <br /> )1, Location of Property: S E A JyV J� <br /> ➢ Section: 33 Township: _39 Range: Size: 5. 04 fl C. <br /> ➢ Legal Description: Lot o C S d ( P 160 <br /> ➢ Current Zoning:U R ZDn e Floodplain Y/N _N Wetlands YIN <br /> New Parcel Information: Q <br /> ➢ Land Surveyor Preparing Plat/Map: I�O q 0.I H Q E Fm A r n <br /> Number of Lots: '3 Proposed Zoning. So,r-n e✓ <br /> ➢ Regional Flood Elevation: <br /> ➢ Will Access to Navigable Body of Water be Provided/Available, YIN: l�J ff <br /> ➢ Type ofAecess (Example: Oudot, Easement, <br /> Etc.): Tu)r7 /\ O c� d <br /> ➢ Proposed Water and Sanitary System: _1 f 1i V C�__"t' <br /> ➢ Proposed Use: Residential: ✓ Commercial: Other: <br /> Date: Fe-L _aa a0©(, Signature <br /> For Office Use Only — Fees Collected. <br /> Date of Land Use Committee Preliminary Acceptance: Action: <br /> Date of Land Use Committee Final Acceptance: Action: <br />