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Provide names and addresses of all adjoining property owners <br /> *Adjoiners are all parcels(including 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 /> Sil S� <br /> a <br /> 5 <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 /> I 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. I 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 /> hearing agenda,and the submittal deadlines will r tart. <br /> Signed <br /> s r�"pycnan (Date) <br /> , <br /> Signed . <br /> ( (D e <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 3/2015 <br />