2021/12/15 - LAND USE - CUP - Conditional Use Permit - CUP-21-31

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'Provide names and addresses of all adjoininl property ()sr ners. *Ad/toners are all parcel (including vao ant parcels)that tow h the applicants panel including those across the road and o• those that only touch at a i mmntun property corner. Address for the owner t4uuld be their mailing address(K here they get their marl)in many cases, this may not be the site address Attach additional sheets if necessary 1111111101111111.11105 — g Qq l"a . !' = in u • orae o /s1 L.-tree/C._ ;; / pi / AAP7rtve-s niltit'(eI It / I • Proposed building/structure locations must be staked prior to submitting this application to the land Services Department. County staff will do an onsite visit to verify site conditions. If site is not staked upon County staff visit this application will be returned to the applicant. Returned application will result in the item being removed from the hearing agenda,and the submittal deadlines will restart. • If all existing structures are not shown and dimensioned on the plot plan drawing the application will be returned to the applicant. Returned application will result in the item being removed front the hearing agenda and the submittal deadlines will restart. • 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 make application to the Burnett County Land Use and Information Committee for a Conditional Use Permit (CUP). I certify that the information 1 have provided in this application (including any accompanying drawings and plans)is true and accurate. I agree to permit County omcials 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. 1 understand that the application fee is non-refundable regardless if the Conditional Use Permit(CUP)is approved or denied. I understand that the fee for this application is only for the Conditional Use Permit (CUP) application and if permits are required for the project that those will require separate fees. I understand that partial or incomplete applications will be returned to ,c applicant resulting in the application being removed from the hearing agenda.and the submittal deadlines will/ort. Signed ' /Or a.--- 1) 3 M pGcant) ----- _ J—.� ,/I (Date) ' /fi,-;.---1 Signed___-.__._ _- 11/__.- _ --- _ _ -- � 1n) __.11/2/2021 (Owner) (Date) (If applicant and owner are different, then both need to sign the application-) Page 3of4 Burnett County, WI Conditional Use Permit (CUP)Application — Rev 1/2021