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;...a Date Filed_ <br /> a PREAPPLICATION CONSULTATION FORM <br /> .� REQUEST FOR APPROVAL - SUBDIVISION <br /> BURNETT LAND USE DEPARTMENT, BURNETT COUNTY GOVERNMENT CENTER <br /> SIREN, WI 54872 <br /> 4 xY <br /> APPLICANT: SAI,/, go-L. -� OWNER: <br /> U (/ 2 <br /> 5Ygg3 <br /> 1 Phone: Phone: <br /> Location of Property: i <br /> T3g� RiaLJ GL� � <br /> .:. S, <br /> Parcel No. 05 Boa <br /> Section Township Range Size jJr�� <br /> Legal description attached. <br /> Names of Subdivision: (2 S v\ <br /> Land Surveyor preparing plat: fou�I ll^Eei e <br /> Current Zoning_ Proposed Zoningll <br /> Number of Lots- <br /> E Will a Planned Unit Development bee required U <br /> Proposed water supply <br /> Proposed sewage system f / <br /> Proposed uses: Residential Commercial P k/Public <br /> Date 4 q Signature <br /> _aI <br /> Fees Collected: <br /> Date of Land Use Committee preliminary acceptance <br /> Action blvuO <br /> Date of Land Use Committee final acceptance y Action <br /> =- <br /> e, <br />