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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: �- <br /> -;.ar Sur�ls,n9g <br /> x'257 -j4J ' iceiand Ave:;ue <br /> Li. <br /> VJsbsier, Wiscarsin .r)�rJ.:J <br /> p�iy&4le-y, GU1 5��30 <br /> Phone: Phone: 70- 866- 83,2y <br /> Original Parcel Information: <br /> > Location of Property: AA10 F06nd&19-G Ayll/Ay 0��yu/y� <br /> > Section: /� �— Township: �Ul✓ Range: // W Size: y �y aCr <br /> > Legal Description: <br /> Current Zoning: tP2 Floodplain(fN Wetland N. <br /> New Parcel Information: <br /> > Land Surveyor Preparing Plat/Map: KC-u 5 t <br /> > Number of Lots: Proposed Zoning: <br /> > Regional Flood Elevation: <br /> > Will Access to Navigable Body of Water be Provided/Availa//bl�: <br /> > Type of Access (Example: Outlot, Easement, Etc.): G- <br /> 1 CL hle- U <br /> > Proposed Water and Sanitary System: <br /> > Proposed Use: Residential: x Commercial: <br /> Date: I d- 15 -O I Signature 00 <br /> BORNE <br /> For Office Use Only — Fees Collected: �°"L Oti <br /> Date of Land Use Committee Preliminary Acceptance: Action: l <br /> Date of Land Use Committee Final Acceptance: Action: I6 <br />