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Pre-application Consultation Form <br /> Request For Approval — Subdivision <br /> Burnett County Land Use!Zonina, Department <br /> Burnett County Government Center; Siren, Wisconsin <br /> Applicant: Owner: O'i rry fk44 4 0 1'►r�� <br /> Phone: Jy "-" - Phone: g� ( S73G <br /> Original Parcel Information: <br /> Location of Property: Lv J3 1 ' S �r rte; .0 ci lq t V 4 <br /> > Section: 3 Z Township: D Range: 14 Size: 74i2 3 c <br /> > Legal Description: S E Al 4 NE NE <br /> > Current Zoning: Q Z- Floodplain YO Wetlands®N: <br /> New Parcel Information: 1 <br /> > Land Surveyor Preparing PlatlMap: MAO { Izn U&C- <br /> > <br /> > Number of Lots: -7 Proposed Zoning. S/�ly►< <br /> > Regional Flood Elevation: <br /> > Will Access to Navigable Body of Water be Provided/Available, <br /> > Type of Access (Example: Outlot, Easement, Etc.): <br /> > Proposed Water and Sanitary System: Pr"t vu f <br /> > Proposed Use: Residential: X Commercial: Other: <br /> Date: °�o l Signature: 6� <br /> For Office Use Only — Fees Collected: � 16'3311 <br /> Date of Land Use Committee PreliminaryAcceptance: Action: W <br /> Date of Land Use Committee Final Acceptance: Action: <br />