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Provide names and addresses of all adioining property owners. <br />di *Adjoiners are all parcels (including vacant parcels) that touch the applicants parcel, inch�ding those across the road and <br />��`� ose that only touch at a common property corner. Address for the owner woz�ld 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 />3 29 S 0 ' S'f'; CrLotu � �--►"�i� � Ott-�`��C��w�-� ?z�IM=.�s-t�2 �J� S�;-$�t � <br />3'tl ? D �}SH-LEy � E�1 n �r�i �5' [�.0 1Zr� C •� � > <br />'15M 1 <br />t.• <br />13?9�TM-VOR %44017d '77-04! R)D '' <br />13799 JCRrI E.Ul15121+/eICE % 7-419 P-p '' <br />✓ (m�vt o-F Oa�4►t - c/ui'�- -- S�ier�,/ a So/� <br />• Proposed building/structure locations must be staked prior to submitting this application to the <br />Land Services Department. County staff will do an onsite visit to verify site conditions. If site is <br />not staked upon County staff visit this application will be returned to the applicant. Returned <br />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 />Signed <br />(Applicant) (Date) <br />Signed _ 4- 4 — 1l <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 1/2019 <br />