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Part D: Provide names and addresses of adioinine Property owners <br /> (To be provided by the applicant) <br /> •Adjoiners are all parcels(including vacant parcels)that touch the applicant's parcel, including those across the road <br /> and those that only touch at a common property corner. Address for the owner would be their mailing address(where <br /> they get their mail)in many cases this may not be the site address. / <br /> ba d d T <br /> �276> <br /> 55 a <br /> u Vo S o <br /> n Q <br /> r^ <br /> J ttv� f wNoy r <br /> I2/Z7 <br /> e W-rIC: ns ar, <br /> Part E: Sienature and date <br /> (To be completed by the applicant and owner. If applicant and owner are different, then both need to sign the <br /> application.) <br /> I certify that the information I have provided in this application is true and accurate. I agree to permit County officials <br /> charged with administering county ordinances or other authorized persons to have access to the above-described <br /> premises at any reasonable time for the purpose of inspection. I understand that the variance fee is non-refundable, <br /> regardless if the variance is approved or denied. I understand that the fee for this application is only for the variance <br /> request and if permits are required for the project that those will require separate fees. I understand that a subdivision <br /> permit and corresponding fee will still be required if this subdivision variance is approved. I understand that partial or <br /> incomplete applications will be returned to the applicant resulting in the application being removed from the hearing <br /> agenda,and the submittal deadlines will restart. <br /> Sign <br /> (Applicant) (Date) V <br /> Signe <br /> '(Owner) (Date) <br /> Page 7 of 8 <br /> Burnett County, WI Subdivision Variance Application—Rev 3/2015 <br />