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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 /> a <br /> APPLICANT: �avc€ ff�sb crime c OWNER: NicK /moa OS&i <br /> �OG47 /7.4,0,, 67. E- <br /> rotoatxS /1 n. ss'3"7°{ cmc L4acc CMJ/. <br /> Phone: Cal a -- 148 —&S/ 8 Phone: /S'c/log�2 f <br /> Location of Property: <br /> 6, L - 13 Parcel No. <br /> Section 3 Township 38 Range /4- Size <br /> Legal description attached. <br /> Names of Subdivision: <br /> Land Surveyor preparing plat: G ve-E 4�:-7c-z ioT"T <br /> Number of Lots / Current Zoning Proposed Zo ing <br /> Will a Planned Unit Development be required /VO <br /> Proposed water supply <br /> Proposed sewage system CONc�a}+T�C✓/a <br /> Proposed uses: Residential L,'� Commercial Park/Public <br /> Date 11 !7 Y Signature <br /> Fees Collected: <br /> Date of Land Use Committee preliminary acceptance Action <br /> Date of Land Use Committee final acceptance Act on <br /> AJ( <br /> i <br />