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s <br /> Part C: Provide names and addresses of all property owners within 300' of the parcel proposed to be rezoned. <br /> This must include all parcels (including vacant parcels) that are within 300'of the parcel proposed to be rezoned, <br /> including those across the road. Address for the owner would be their mailing address(where they get th•' • .il) in <br /> many c'ses this may not be the site address. Attach additional sheets if necessary. <br /> Michael O'Bri- - 7167 Connors Bridge Rd Webste _ A 893 Tax id# 11073 <br /> Patrick & Nancy 0': 4 PO Box 447 We. . - 154893 Tax id# 11089 <br /> Diane Medaglia PO Box - _ -r WI 54893 Tax id# 11088 & 11078 <br /> Jeffrey & Staci Peters.• 22 4 •; • St Thompson IA 50478 Tax id# 34535 <br /> Taylor Hei . 6 County Rd A Webst- 4 154893 Tax id# 11075 <br /> CR 024.4e1 /1P • <br /> Part D: Signature and date <br /> (If applicant and owner are different then both need to sign the application.) <br /> I hereby petition the Burnett County Land Use and Information Committee for an amendment to the Burnett County <br /> Ordinance and/or map to effect a change in the Zoning classification. I certify that the information I have provided in this <br /> application 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. I <br /> understand that the petition application fee is non-refundable,regardless if the petition is approved or denied. I <br /> understand that the fee for this petition application is only for the petition request, and if permits are required for the <br /> project,those will require separate fees. I understand that partial or incomplete applications will be returned to the <br /> applicant resulting in the application being removed from the hearing agenda, and the submittal deadlines will restart. <br /> Signed 49'-11-05t �-- � <br /> (Applicant) (Date) <br /> �] A <br /> Signed J ice6--,s oZ <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 Application/Petition for Rezone—Rev 3/2016 <br />