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Names and addresses of adjoining owners continued(if needed): <br /> Part E: Signature and date <br /> (To be completed by the applicant and owner. If applicant and owner are dfferent, then both need to sign the <br /> application.) <br /> I certify that the information I have provided in this application is true and accurate. 1 agree to permit County officials <br /> charged with administering county ordinances or other authorized persons to have access to the above-described premises <br /> at any reasonable time for the purpose of inspection. I understand that the variance fee is non-refundable,regardless if the <br /> variance is approved or denied. I understand that the fee for this application is only for the variance request and if permits <br /> are required for the project that those will require separate fees. I understand that partial or incomplete applications will <br /> be returned to the applicant resulting in the application being removed from the hearing agenda,and the submittal deadlines <br /> will restart. <br /> Signed /tgeatiteg J 7 '- <br /> L4i' <br /> pl ( e) <br /> Signed <br /> 17/20=33 <br /> ( caner) (Da ) <br /> SUBMIT COMPLETED APPLICATION,MAPS,PLANS,AND FEE TO: <br /> BURNETT COUNTY LAND SERVICES <br /> 7410 COUNTY ROAD K,#120 <br /> SIREN,WI 54872 <br /> APPLICATIONS WILL BE ACCEPTED VIA USPS,ANY STANDARD COURIER.OR IN PERSON. COMPLETE <br /> APPLICATIONS WITH ALL REQUIRED SUBMITALS MUST BE RECEIVED BY THE LAND SERVICES <br /> DEPARTMENT BY THE DEADLINE. PARTIAL OR INCOMPLETE APPLICATIONS WILL BE RETURNED TO <br /> THE APPLICANT. ONLY COMPLETE APPLICATIONS WITH ALL REQUIRED SUBMITALS AND REQUIRED <br /> FEE WILL BE INCLUDED ON THE HEARING AGENDA. NO EMAIL OR FAX APPLICATIONS WILL BE <br /> ACCEPTED. <br /> ONLY CHECK,MONEY ORDER,OR CASH PAYMENT WILL BE ACCPETED. CREDIT OR DEBIT CARDS <br /> ARE NOT ACCEPTED AT THIS TIME. MAKE CHECK PAYABLE TO: BURNETT COUNTY LAND SERVICES <br /> Please call the Land Services Department if you have questions. 715-349-2109 <br /> Burnett County,WI ordinances can be found at: http://www.burnettcounty.com/index.asnx?NID=1043 <br /> Page 8 of 9 <br /> Burnett County, WI Variance Application—Rev 12/2022 <br />