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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: &&- fflorro ti) <br /> (A) 25T6 93D-t L1u <br /> _R i ixrF�113 Lits sl/o a a <br /> Phone: Phone: <br /> Original Parcel Information: �6r, Pw� er t� S OI -5416 <br /> < < 1 + 5`-15 Lzt- /o <br /> ➢ Location of Property: ,LOON a ee L :55-o L-t t l <br /> ➢ Section: ? Township: 1 Range. �_ Size: <br /> ➢ Legal Description: 0+_5 (7-104 ( 1 — SM U o ) q <br /> ➢ Current Zoning:W__3Floodpla' Tyl _ Wetlands YIN: <br /> New Parcel Information: 1 J 6� �� ''`'� 3 <br /> ➢ Land Surveyor Preparing Plat/Map: o6et� e�2/^,S <br /> ➢ Number of Lots: a Proposed Zoning: SA/Y)K-7 <br /> ➢ Regional Flood Elevation: iL LA16 t✓A , <br /> ➢ Will Access to Navigable Body of Water be Provided/Availabl&I _� iree lC <br /> ➢ Type of Access (Example: Outlot, Easement, Etc): <br /> ➢ Proposed Water and Sanitary System: <br /> ➢ Proposed Use: Residential. , Commercial: Other: <br /> Date: Q/—OZ-03 Signature: CLG(,/ �7<I �56:, <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 />