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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 /> erorne /Odae?tt 2-527G0 Sluk-mid 3 5 Weer.- W i 51-gq 3 <br /> 3011-Den /as Fic t PO SP3, Luck- W/ 9-/853 ( <br /> No" !� Z�il"►ieZ.717arliiraIla keir4 lvtiif ff-MtiaiMi"iini//% <br /> Z.I D i- k ino-h /Iczn , 2530!0 51 Le ad 1/iri :i O <br /> T,x lis : 12411' / 3277C7 32.970 <br /> rpt—k Cie- ^k--- <br /> /Um�7r.�S i✓Iai'kd c3// /z/ <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. 1 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 submitta de. a lines will restart. <br /> Signed �� e0/. I <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 />