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Date Filed <br /> PREAPPLICATION CONSULTATION FORM <br /> REQUEST FOR APPROVAL — SUBDIVISION <br /> BURNETT LAJ4D USE DEPARTMENT, BURNETT COUNTY GOVERNMENT CENTER <br /> SIREN, WI 54872 <br /> 4 ,o <br /> APPLICANT: OWNER: JyC, <br /> Wagner rveying Associates, Inc. <br /> 26795 Lakeland Avo. N. <br /> (betel, <br /> WI SU93(715) 866 4995 <br /> J <br /> Phone: ( /S -�/d 95� Phone: r7157 ye�(1/— S�Z SO <br /> Location of Proper y: 4� >A l <br /> Parcel No. <br /> Section_ Township p v Range_L2 7,) Size CCC <br /> Legal description attached. —1 <br /> Names of Subdivisi n: <br /> Land Surveyor preparing plat: 17, P <br /> Number of Lots I °v (`l- Current Zoning Proposed Zoning �R 1 <br /> Will a Planned Unit Development be required <br /> Proposed water supply <br /> Proposed sewage system N l i4 <br /> Proposed uses: Residential Commercial X Park/Public <br /> Date 61t Signature maw <br /> Fees Collected: <br /> Date of Land Use Committee preliminary acceptance Action <br /> Date of Land Use Committee final acceptance Action <br /> r <br />