Laserfiche WebLink
r <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 /> "Go it K }vi 7 T$ l,' <br /> (i'0 2 n zr 3.931 7 Sf - 7c� 2��f o <br /> 0 g/ 7 <br /> C2Ct '' is le , MA) cri ZY ‘t'vrm W= Fre la_ 21373 <br /> `/ /a i r <br /> f C/ � /G'd �. e� 4l> 2 Z�� �d,,,,on of ,Sty I'0 SS Gu✓- <br /> L7Cts,61,,I., . t -J S'�'/ �O <br /> t Ol4 of . t.4.91 SS C.rerh._ <br /> Po /err Mahe 7 1�; <br /> .S C e 2.d 2►2.407 <br /> ,1 �'� • Proposed buiiding/structure locations must be staked prior to submitting this application to the <br /> D Land Services Department. County staff will do an onsite visit to verify site conditions. If site is <br /> jenot staked upon County staff visit this application will be returned to the applicant. Returned <br /> 'v` �2� 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 restart. <br /> c / <br /> Signed '� 2/d/?e�2, <br /> (Appl ant) (Date) <br /> Signed 2 ) 7 <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 12/2023 <br />