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Al <br /> Date Filed -�a <br /> PREAPPLICATION CONSULTATION FORM <br /> REQUEST FOR APPROVAL - SUBDIVISION <br /> BURNETT LAND USE DEPARTMENT, BURNETT COUNTY GOVERNMENT CENTER <br /> SIREN, WI 54872 <br /> APPLICANT: u1hez 4 �hg!y /L/,o,,,,, OWNER: <br /> 14 <br /> m!f/6/f/JL � irr✓4 s�ias <br /> Phone: Phone: <br /> Location of Property: Gi / $, ��4 <br /> Parcel No. <br /> Section ) Township 37AI Range /pl b/ Size <br /> Legal description attached. <br /> Names of Subdivision: <br /> Land Surveyor preparing plat: / �p,,Z,Q <br /> Number of Lots ( Current Zoningroposed Zoning --c,.7 <br /> Will a Planned Unit Development be required <br /> Proposed water supply + 5 y,l, <br /> Proposed sewage system /`n y„„�L <br /> Proposed uses: Residential--,�, Commercial Park/Public <br /> Date as �� 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 />