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Date Filed <br /> PREAPPLICATION CONSULTATION FORM <br /> REQUEST FOR APPROVAL — SUBDIVISION <br /> BURNETT LAND USE DEPARTMENT, BURNETT COUNTY GOVERNMENT CENTER <br /> SIREN, WI 54872 I, . <br /> APPLICANT: OWNER: Ker� '� YVbNNG 911111er <br /> Wagner Surveying Associates, Inc. <br /> 26745 Lakeland AVG. N. <br /> P4. ou 89 <br /> WdWw, WI54899 FA/1/*v G/nv. /�rgll� mil. SS07S <br /> Phone: Phone: <br /> Location of Property: G L / 4 Al -lw ex,t{; a CJntr <br /> L>}k IV 4- y0( Ip IC}Ay.( 2 �)11 Parcel No. <br /> Section 24 Township 4D Range Size Z Act, <br /> Legal description attached. I <br /> Names of Subdivision: C s rn / <br /> Land Surveyor preparing plat: r/ry!2 <br /> Number of Lots 2 Current Zoning R� ? Proposed Zoning SAS` <br /> Will a Planned Unit Development be required A10 <br /> Proposed water supply &LIA7c <br /> Proposed sewage system Trlvp.Fc <br /> Proposed uses: Residential Commercial Park/Public <br /> Date 7//S Signature Z . AV4A�; <br /> Fees Collected: <br /> Date of Land Use Committee preliminary acceptance Action <br /> Date of Land Use Committee final acceptance Action <br /> r <br />