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-FIP5T Anv . 'Ta LipsiE Fir.1�5 6v8pt,,4i5t6o a17 <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: M i t LI Ac—l_. 1o 7 To V� Owner: I v 1 c."A E L I , <br /> 2-034 ovt-lr A <br /> .J Pa o cJ E-rz 11C.(Z <br /> Phone: '1 5 - Co 3 S _ -1 g,z, Phone: <br /> Original Parcel Information: <br /> ➢ Location of Property: E - 5 C f . L - 3 <br /> ➢ Section: 1 2 Township: 3 Range: �_ Size: 55. 55- io TA L, <br /> Legal Description: <br /> ➢ Current Zoning: Floodplain YIN: PJ _ Wetlands YIN.- j _ <br /> New Parcel Information: <br /> ➢ Land Surveyor Preparing Plat/Map: M E- t-J o -rz-rc ,Q <br /> ➢ Number of Lots: g Proposed Zoning: <br /> ➢ Regional Flood Elevation: <br /> ➢ Will Access to Navigable Body of Water be Provided/Available, YIN.- <br /> ➢ Type of Access (Example: Outlot, Easement, Etc.): t <br /> OV+JT4 �L� fi tiClST� �21YATt <br /> ➢ Proposed Water and Sanitary System: o <br /> }�fZ� v,c4Tic <br /> ➢ Proposed Use: Residential: X Commercial: Other: <br /> Date: Signature: <br /> For Office Use Only — Fees Collected: E� <br /> Date of Land Use Committee PreliminaryAcce tante: <br /> P J Action: Ll' Z 90, <br /> Date of Land Use Committee Final Acceptance: Action: <br />