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• <br /> 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 /> \ David & Nancy Brown 24959 Kruger Rd, Webster WI 54893#32966 <br /> v\ Timothy Cross 100 Tootys Ave, Yankton SD 57078#36254 <br /> 3 ML Hoist LLC 852 138th St, Amery WI 54001 #36255 <br /> tj Erickson Family Investments LLC PO Box 614, Webster WI 54893#36268& 12696 ./W <br /> \ !Rebecca Lamphere 25020 Kruger Rd, Webster WI 54893#12387 IU �� j <br /> '6`.• John Armstrong JR PO Box 197, Siren WI 54872#12398 <br /> \ Chad Noll 24697 County Rd X, Shell Lake WI 54871 #32034 Ii11(p'�v <br /> g ' Philip Smith 20401 N State Rd 29, Chillicothe IL 61523#12403 <br /> q Adam Imme 24920 Leghorn Dr, Siren WI 54872#12404 <br /> 10', Corey& Laura Buck 14319 Underclift St NW, Andover MN 55304#12405 <br /> II • Thomas Grashorn 2374 Erin Ct, New Brighton MN 55112#35057 t Ud�� <br /> I1.\ Richard Rossow Jr 27975 Moser Dr, Webster WI 54893#34938 �-i �/Ni e' /7 <br /> 13� Dawn Sheldon 6909 State Rd 70, Siren WI 54872 #12416 See attached DN aNOT ^' CJ <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. I 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 submittal deadlines wi I resta <br /> Signed 11 f -‘2' 2 <br /> (App icant) (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 12/2021 <br />