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Pre-applic:�tion Consultation Form <br /> Request '117or Approval — Subdivision <br /> Burnett County Land Use!Zonir.g Department <br /> Burnett County Covernniemt Center; Siren, Wisconsin <br /> Appilicant: Owner:�rrry_av�1,4 0��+r^-� <br /> 3�tGj f itJ 910 <br /> J <br /> Phone: ` " Phone: <br /> Original Parcel Information: <br /> Location of Property: Lv1s I - $ JrP,r ;j u fj1A1e., 4 <br /> > Section: 3 Z— Township: 40 _ Range: 6 Size: <br /> i <br /> > Legal Description: S E A1E 4 A)4 &_e <br /> > CurrentZoning: QA*L Floodplain Y0 Wetlands®N.• <br /> New Parcel Information: n <br /> > Land Surveyor Preparing PlatlMap: /'►nk Kin us <br /> > :Number of Lots: -7 Proposed Zoning: SA&c <br /> > Regional Flood Elevation: <br /> > Will Access to Navigable Body of Water be Provided/Available, N <br /> Type of Access (Example: Outlot, Easement, Ftc.): T_.. <br /> > Proposed Water and Sanitary System: Pr,vu <br /> > Proposed Use: Residential: X Commercial: Other: --. <br /> Date: Signature: <br /> Signature: <br /> 6 4U1 <br /> For Office Use Only — Fees Collected: N NGV► vrY <br /> Date of Land Use Committee Preliminary Acceptance: Action: <br /> Date of Land Use Committee Final Acceptance: Action: / <br />