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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. <br />See Attached <br />• Proposed building/structure locations must be staked prior to submitting this application to the <br />Zoning Office. County staff will do an onsite visit to verify site conditions. If site is not staked upon <br />County staff visit this application will be returned to the applicant. Returned application will result <br />in the item being removed from the hearing agenda, and the submittal 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 <br />inspection. I understand that the application fee is non-refundable regardless if the Conditional Use Permit (CUP) is <br />approved or denied. I understand that the fee for this application is only for the Conditional Use Permit (CUP) <br />application and if permits are required for the project that those will require separate fees. I understand that partial <br />or incomplete applications will be returned to the applicant resulting in the application being removed from the <br />hearing agenda, and the submittal deadlines will restart. <br />Signed _S - �`^^---- <br />(Applicant) <br />.2'.2g -/f <br />(Date) <br />Signed 1A_ 2 ',2F -(;?- <br />(Owner) <br />(l <br />(Owner) <br />(Date) <br />Page 3 of 4 <br />Burnett County, WI Conditional Use Permit (CUP) Application — Rev 1/2018 <br />