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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 /> +A heir mail) in many cases, this may not be the site address. Attach additional sheets if necessary. <br /> 1q F! -.25123 Clam Shell Ln =Marlin and Susanne Madery 61217 251ST Ave, Mantorville MN 55955 10 <br /> ✓PRPID:12460 = James and Beth Nelson 25027 Clam Shell Ln, Siren WI 54872 V <br /> No _ - - -• ; -..; - _. _: - , .. . . ;;• <br /> e. iasier a ' <br /> .itrwfacumwro , ' <br /> ©74ce�5 <br /> 1,4c acci S//Z,wvf <br /> • Proposed building/structure locations must be staked prior to submitting this application to the <br /> Land Services Department. County staff will do an onsite visit to verify site conditions. If site is <br /> not staked upon County staff visit this application will be returned to the applicant. Returned <br /> application will result in the item being removed from the hearing agenda, and the submittal <br /> 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 /> • THIS APPLICATION CONSTITUTES NOTICE THAT ALL IMPROVEMENTS ARE SUBJECT <br /> TO ACCESS AND/OR REVIEW BY THE LOCAL MUNICPALITY'S TAX ASSESSOR FOR <br /> THE PURPOSE OF TAX ASSESSMENT <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 inspection. <br /> I understand that the application fee is non-refundable regardless if the Conditional Use Permit(CUP) is approved or <br /> denied. I understand that the fee for this application is only for the Conditional Use Permit(CUP) application and if <br /> permits are required for the project that those will require separate fees. I understand that partial or incomplete <br /> applications will be returned to the applicant resulting in the application being removed from the hearing agenda, and <br /> the submittal deadlines w' rest. t. /� <br /> 10411111111.111/A.--,--- <br /> Signed /� 4 // Z( <br /> (Applies (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 1/2021 <br />