2021/11/10 - LAND USE - MAP - Rezone - MAP-21-11

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,y . • 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. ii-- North Camp Properties II LLC, 5120 Windward Ave, Siesta Key FL 34242 Tax ID#5448 y- ®- Ronald & Kathleen Derrick Trust, 1462 112th Ave, New Richmond WI 54017 Tax ID#5447'& 5449✓ a - Steven & Margaret Derrick, 259 Troon Ct, Hudson WI 54016 Tax ID#5450 f c� - Jeanne Derrick Trust, 4429 Dorchester Dr, Woodbury MN 55129 Tax ID#5467&5465 s - Voyager Village POA, 28851 Kilkare Rd, Danbury WI 54830 Tax ID#8310,- $j,ZT 1823o fig21,7/ © - -meq Som 6v,7;54 1/00? -The stos live_$ B1+owmit 710.1 AV sSc'3/ T92/7 0- -Thboli epf mat c f CA/N/4-- &-&,- CnuK i3ma�S pellitSDr DikinCT- /9— Cra• Con yrn Ablitte4 10.41 #2/7.4 Part D: Signature and date (If applicant and owner are different then both need to sign the application.) THIS APPLICATION CONSTITUTES NOTICE THAT ALL IMPROVEMENTS ARE SUBJECT TO ACCESS AND/OR REVIEW BY THE LOCAL MUNICPALITY'S TAX ASSESSOR FOR THE PURPOSE OF TAX ASSESSMENT 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 the ap.lication .!ng removed from the hearing agenda,and the submittal deadlines will restart. Signed I114? % // P,-j • . .n ate / p t) ) Signed 4,1W i� 4 �' J 6. , j (Owner /� (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 11/2019