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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 /> l/gNb C-ez!`wn'o' ,CN 0 SALC/F A/sin//n/GG>t <br /> G o <br /> Applicant: TEL.0 �S ,w acv S o nl Owner: lll/es/q E�1_ <br /> S=. .NSON T.AND SURVEYING,INC. <br /> 25070 State Road 35 54872 <br /> sii6$,WT /✓N 1r lid CJs MAI S3 j <br /> Phone: 7/,45- 341 5z6-3 Phone: 617- 7/3 s/4-6 <br /> Original Parcel Information: <br /> ➢ Location of Property: G C- S <br /> ➢ Section: Z Township: 4-0 Range: /P Size: e '86 ,¢ <br /> ➢ Legal Description: Y ¢73 P 63.7 l/¢/5- P/S4— <br /> ➢ Current Zoning: RK Z Floodplain YIN A114 Wetlands YIN: n/d <br /> New Parcel Information: <br /> s' <br /> ➢ Land Surveyor Preparing Plat/Map: _ ] om,ws fwsn/S o A/ <br /> ➢ Number of Lots: 2 C-Xfsr/n/ G PA&c�etyiposed Zoning: f <br /> A10 NS4v L rs <br /> ➢ Regional Flood Elevation: Nv dAsE Fco &c E✓sr ri a <br /> ➢ Will Access to Navigable Body of Water be Provided/Available, YIN: yC-S <br /> 1 <br /> ➢ Type of Access (Example: Outlot, Easement, Etc): D,/xcCr <br /> ➢ Proposed Water and Sanitary System: /'it-A rE �y� <br /> ➢ Proposed Use: Residential: X Commercial: Other: �G <br /> q <br /> d <br /> Date: zoa3 Signature: <br /> For Office Use Only — Fees Collected: <br /> Date of Land Use Committee Preliminary Acceptance: Action: U.) <br /> Date of Land Use Committee Final Acceptance: Action: <br /> i©� Ul <br />