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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 <br /> APPLICANT: OWNER: <br /> \X��PaS`rE�. `1� �i \x(�F35'rZ✓2 } � l <br /> Phone: Phone: <br /> Location of Property: Goat"T ` -�T Co <br /> Parcel No. <br /> Section Township .40 Range I L} Size Z• i ( /tL2 CS <br /> Legal description attached. <br /> Names of Subdivision: <br /> Land Surveyor preparing plat: <br /> .F uo <br /> Number of Lots Current ZoningProposed Zoning E6i — <br /> Will a Planned Unit Development be required A-1 D <br /> Proposed water supply Pr I az)? <br /> Proposed sewage system eJ't � <br /> Proposed uses: Residential Commercial Park/Public <br /> Date Signature <br /> Fees Collected: <br /> Date of Land Use Committee preliminary acceptance Action <br /> Date of Land Use Committee final acceptance Action <br /> r <br />