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z <br /> APPLIC TION/PETITION FOR REZONE— Burnett County, WI <br /> 21 <br /> FEE: $300.00 APPLICATION#:MAP. <br /> COMMITTEE MEETING DATE: 1 1/ 24 20 Z <br /> DATE RECEIVED: q/Z-3/2.46 a, CURRENT ZONING DISTRICT: f- <br /> PARCEL#(24 digits): 6 7'd/Z "2^ifO^/f- Zl -I OV-000 - O//00© <br /> PROPOSED ZONING DISTRICT: A R - 3 <br /> RECEIVED STAMP(BELOW): <br /> TAX ID#: S�.S7 <br /> ION TAKEN BY LAND USE AND INFORMATION COMMITTEE: blECIEOVEn <br /> APPROVED ~ <br /> �z ZD Z1 SEP 2 3 2021 <br /> DENIED MEETING DATE: 1 - eve g - <br /> .7../. - <br /> TION TAKEN BY COUNTY BOARD OF SUP RVISORS:„,K <br /> Burnett County <br /> APPROVED q Land Services Department <br /> DENIED MEETING DATE: 11 / ZOZ� <br /> ACTION TAKEN BY TOWN BOARD OF SUPERVISORS.TOWN OF �q G//C.S Oil <br /> ❑APPROVED <br /> ❑DENIED MEETING DATE: ..i .1 - - , Q <br /> MAP UPDATED BY:____Til, iV a r DATE: Vt t Op a I/ <br /> ZONING STAFF ONLY ABOVE THIS LINE <br /> Applicant Complete All Remaining Sections Below <br /> Part A: <br /> Property Owner's Name:Thomas & Janice Derrick Trust <br /> Applicant's Name: Thomas Derrick <br /> Applicant's Mailing Address: 1412 160th Ave New Richmond WI 54017 <br /> City State Zip <br /> Applicant's Telephone Number: 612-919-7330 <br /> Applicant's Email: tomed91955Ca)gmail.com <br /> If staff has a question about this application,how do you prefer to be contacted? Check one below: <br /> ❑Letter ®Phone ❑Email <br /> Legal Description: SE-NE ex CSM V12 P203 <br /> Lot#: CSM Vol. Pg. OR <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: OR SE 1/4 NE 1/4 <br /> Serlion”: 21 Town#:40 N Range#: 15 W Town of:Jackson <br /> *Attach additional:-age if needed for lengthy description OR attach a cnnv of the deed OR attach tax system property page.* <br /> Page 1 of 4 <br /> Burnett County,WI Application/Petition for Rezone—Rev 11/2019 <br />