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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.ddAttach additional sheets if necessary. <br /> / ,L�r./ -Ed .�.c, l a 1( Z — 2 Z -e 0 9. <br /> ✓' <br /> rct h-E s 1 , T Zc _ Z Z r ! i9 v' <br /> [�► c -DoT . 7_( 0'62 ( <br /> B u MM of t-G•a 14.17 Fm ve_ . 7a,re. Zr .-- <br /> 5-t.1 E - Tri /VI 2/ c <br /> 1 OF• 5rotss C/ - <br /> z <br /> 1014 ,DDT -- /7a( N V' it' Sye441.0 tor_ 830 <br /> ` L <br /> r - ' A' 4 • / + Li' " < 4' S(1e 6P <br /> 3 <br /> e mast - 3085/Red J e tc T/ �1 4.1,1,r UJ= SSz'3o <br /> r I CPM _ • A _ - S7327 it.= 2'7 <br /> • Proposed building/structure locations must be staked prior to submitting this application to the <br /> N )1,y Land Services Department. County staff will do an onsite visit to verify site conditions. If site is <br /> p I not staked upon County staff visit this application will be returned to the applicant. Returned <br /> t application will <br /> �U� pp w�l result in the item being removed from the hearing agenda,and the submittal <br /> ,� deadlines will restart. <br /> I` • 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 will restart. <br /> Signed )4,0.1Y 1Y Z Z <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 1/2021 <br />