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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. 7( I`+' <br /> tau re_ 04 `N"1-J2-- 'n€At 0-fS <br /> OW% er'S -- 'ma rre... w,Ie-IfIDUJr) <br /> Pa ►-, —v1/4 ' o 0 r` i. <br /> . 4c,n)1dti t 644y tSA1 /V7�f sN4,CO /9te. ss Quf e Am' SS3/3 IC l.7banl'e, o Sa/1 f✓'ce g3zs1147PAr rQ i T �a v c. i1� 3 7gig7$3 8 <br /> / � SS /S9f� <br /> 3 We?r+c.+N 154 ' ^s T /.593/ /c2 s7- for . M/U cTos6 I31S7 <br /> 9t c C $/kAPP/7 `t /lfder1"1Gr1 /10f/L 1�1Glul J21'! MeW - 7/ 75T g8' <br /> T o,c Rus 1S9lo 7 <br /> d Tay ©lc' x u s qeo go n n lc_ AwciA,v` <br /> griTtoil ot Ru s,e.- duly' K 8'ss c <br /> r', p� Proposed building/structure locations must be staked prior to submitting this application to the <br /> �o (L� Land Services Department. County staff will do an onsite visit to verify site conditions. If site is <br /> �� Ati not staked upon County staff visit this application will be returned to the applicant. Returned <br /> 4 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 will res rt. <br /> Signed 61 1 K /23 <br /> ( c t) (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 1/2021 <br />