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Provide names and addresses of all adjoining aroaerty owners <br /> *Adjoiners are all parcels(inc•luding vacant parcels)that touch the applicants parcel, including those across the road and <br /> those that only touch at a common:property corner. Address for the owner would be their mailing address(where they get <br /> their mail)in many cases, this may not be the site address. Attach additional sheets if necessary. <br /> CSC <br /> a s <br /> Fu/I 3 OOta /S� �G /S� awbuN <br /> aK .ds zzlzg ,:t — 78'00 Gou <br /> rP0$46pta —?�'3�f GouH A�OF kf r <br /> r % Z ocM to — 5010 &bapv <br /> u 40, 23 03 , — 30 27 Af 7 0 Ave, &Ft 4r <br /> 1-1-nC ` J` o Pay 1327-r� It,I Ute <br /> • Proposed building/structure locations must be staked prior to submitting this application to the <br /> Zoning Office. County staff will do an onsite visit to verify site conditions. If site is not staked upon <br /> County staff visit this application will be returned to the applicant. Returned application will result <br /> in the item being removed from the hearing agenda,and the submittal deadlines will restart. <br /> • If all existing structures are not shown and dimensioned on the plot plan drawing the application <br /> will be returned to the applicant. Returned application will result in the item being removed from <br /> the hearing agenda and the submittal deadlines will restart. <br /> hereby make application to the Burnett County Land Use and Information Committee for a Conditional Use Permit <br /> (CUP). I certify that the information I have provided in this application (including any accompanying drawings and <br /> plans)is true and accurate. I agree to permit County officials charged with administering county ordinances or other <br /> authorized persons to have access to the above-described premises at any reasonable time for the purpose of <br /> inspection. 1 understand that the application fee is non-refundable regardless if the Conditional Use Permit(CUP)is <br /> approved or denied. I understand that the fee for this application is only for the Conditional Use Permit (CUP) <br /> application and if permits are required for the project that those will require separate fees. I understand that partial <br /> or incomplete applications will be returned to the applicant resulting in the application being removed from the <br /> hearinga e , n e s bmiittal deadlines will restart. <br /> Signed o � 3-/1/-/ 7 <br /> (Applicant) (Date) <br /> Signed <br /> (Owner) (Date) <br /> (If applicant and owner are different, then both need to sign the application.) <br /> Page 3 of 4 <br /> Burnett County, WI Conditional Use Permit(CUP)Application—Rev 3/2017 <br />