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Provide names and addresses of all adioinin2 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. (F�-� <br /> a 1 ♦ - r AlF <br /> gacc aa .311\u,' IVLw0e3i - %Li(i, Ct.t3v\tyzaick 'c),026.kc, v.) s'Lack'5 10%,If <br /> g Unkc, ,3J.A3e <br /> Xi - a(S1 Ctu( It 'DI s , vit sl-k 7c15 is 9 3 <br /> {1Lass4w Mcao9ewt at/s'6et ofi`'rel 70 <br /> lip <br /> l& .7VIN C ptl Af110e c "\ a/1 -q 4a7 61A5/1\\A, rux,(k 6 \,..)eicwi <47cis ,DgET- <br /> cP to IFFId A' f/t'tiGf 7/rvv l84i c_f hilt. r NI/V SS'5Z3 3249l D <br /> ZOe_ Pvb,w`zies po$ox l?o _544/ l.0/6-e- St/g 7/ /oySB- <br /> ton eYF G/it 9/ t ClcA^ <br /> • Proposed building/structure locations must be staked prior to submitting this application to the <br /> ik pry 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 /> ifit 7517 deadlines will restart. <br /> `I U • 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 will restart. <br /> Signed (LA/(JL \ ./teck...." %ct/a3 <br /> L (Applicant) (Date) <br /> Signed 6Lc <br /> (Owner) ( ate) <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 />