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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 /> 1/gNbCrZ�o/Z[� KNOSALGA /{C/A//'NGB/C <br /> Applicant: rion•P�S o t_1 Owner: /y/elo E�L 1/4NbtrizGo/aoD . <br /> SV�ENgGN 1,AND SURVEYING,INC. ¢/s¢ BL,4/SD SL L '01/ <br /> 25070 State Road 35 54878 <br /> Siren,Wi 1'!i,✓N c a pac✓S /'//�/ S3 wog <br /> Phone: 7t_5- 34-7 5z63 Phone: (9/z. 7/3 S Y4-6 <br /> Original Parcel Information: <br /> ➢ Location of Property: G L 4 ' <br /> ➢ Section: z Township: 4-0 Range: /(a Size: J , 86 ,q <br /> ➢ Legal Description: Y 4=7- ¢73 P 6 37 1/¢/5- P S¢, r p <br /> ➢ Current Zoning: Rik Z Floodplain YIN.- /L//A Wetlands YIN: /L/d <br /> s. <br /> New Parcel Information: <br /> ➢ Land Surveyor Preparing Plat/Map: 7/_Kc o,.4S ,fw Fn1S o 1✓ <br /> ➢ Number of Lots: Z /_Xf5r)Al G p,42c44DtVposed Zoning: ' <br /> /✓o /USw &4-7-S <br /> ➢ Regional Flood Elevation: No BASE FC.o[xo '54F✓R ri 0^j (�1 <br /> ➢ Will Access to Navigable Body of Water be Provided/Available, YIN.- S <br /> �j <br /> 1 <br /> ➢ Type of Access (Example: Outlot, Easement, Etc): Ohe cCr <br /> ➢ Proposed Water and Sanitary System f'itit1ArT <br /> ➢ Proposed Use: Residential: X Commercial: Other: <br /> Q <br /> d <br /> Date: J7/'.j& Gloe 000-3 Signature: <br /> For Office Use Only — Fees Collected: <br /> Date of Land Use Committee Preliminary Acceptance: Action: w <br /> Date of Land Use Committee Final Acceptance: Action: <br /> ,�� <br />