2017/03/24 - LAND USE - MAP - Rezone (5)

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Part C: Provide names and addresses of all property owners within 300'of the parcel proposed to be rezoned. This must include all parcels(including vacant parcels)that are within 300'of the parcel proposed to be rezoned, including those across the road. Address for the owner would be their mailing address(where they get their mail)in many cases this may not be the site address. Attach additional sheets if necessary. S Ot - QTIH Fon LT N-evJ 'v6 N 55 N'lo - 2/ IAJ s _ Ly L- a 5 U u N 500(a i lL - Lppaiflr A S� z kof) nn - loct1 9 SA , Rd -in Sir�r_ LNs w oL �a ,-1 - of w a / s N S�1020 !�l LL a c� ,yen Si2q-� 1a Part D: Sienature and date (If applicant and owner are different then both need to sign the application) I hereby petition the Burnett County Land Use and Information Committee for an amendment to the Burnett County Ordinance and/or map to effect a change in the Zoning classification. I certify that the information I have provided in this application is true and accurate. I agree to permit County officials charged with administering county ordinances or other authorized persons to have access to the above-described premises at any reasonable time for the purpose of inspection. I understand that the petition application fee is non-refundable,regardless if the petition is approved or denied I understand that the fee for this petition application is only for the petition request,and if permits are required for the project,those will require separate fees. I understand that partial or incomplete applications will be returned to the applicant resulting in application being removed from the hearing agenda,and the submittal deadlines will restart. sign9LI (Applicant) I (Date) sign y✓ 921 I -3-I (Owner) I (Date) (If applicant and owner are different, then both need to sign the application.) Page 3 of 4 Burnett County,WI Application/Petition for Rezone—Rev 3/2016