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Pre-application Consultation Form <br /> Request For Approval— Subdivision <br /> l Burnett County Land Use/Zoning Department <br /> S 1 Burnett County Govern ent Center; Siren, Wisconfsi( <br /> ELAG sC f� <br /> � /71 l�715 C'M /S —(z✓ <br /> apPlicant: Wagner Surveying Associates, Inc. Owner: 1?lch�to <br /> 2�Lan venue <br /> N. S, <br /> P.O. Box 89 /680 9 a, P� <br /> fi s er, isconTn <br /> 715-866-4295 Adev s X, fly F54 y9 <br /> Phone: Phone- <br /> Original Parcel Information: p Q <br /> ➢ Location of Property: PACT ROAp - Gitc-14 LAk'L <br /> ➢ Section: .27 Township: y0 Al Range: 15 0/ Size: 5,&V` QC&L41 <br /> ➢ Legal Description: 1�0 V t LO T .2� <br /> ➢ Current Zoning: _ Floodplain Y,0 Wetlands Y© <br /> New Parcel Information: <br /> ➢ Land Surveyor Preparing Plat/Map: <br /> ➢ Number of Lots: Proposed Zoning: 544 <br /> ➢ Regional Flood Elevation: <br /> ➢ Will Access to Navigable Body of Water be Provided/Available, YV <br /> ➢ Type of Access (Example. Outlot, Easement, Etc): '~ <br /> ➢ Proposed Water and Sanitary System: PrIVA f-4 <br /> Proposed Use: Residential: _ Commercial: Other: <br /> Date: g- l9- 0 / Signature: <br /> Mak <br /> 'r <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 />