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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 /> cerNg <br /> 3387 �C av 4� cs- 99 GA) /Via C4.4or , !! <br /> ? ' tP*> iGse/ Gyb6owde4 5S0 kilo( , N B ,t Cir MN _M119 <br /> 31.C3) <br /> 335'9��.1+a t 7e! ./uf// /SO fie//ir St /a3 r.J .7 7LRim/ /410 S.57 <br /> Sig / ' <br /> 3357? 4$O$ I h SDI(ar�GV" /670 ,Al/c7L . 0,r.{k,m) /'/V SS/Z.<0 <br /> orlee6a0-,es M4$K,'l /0/ / tt 4 $ 1-44Ns MN .C5-3y3-7V3 <br /> 121W)4wa1 &rtke 2S6(0 /1$ Lorne. Alk) Godh goes MAI .s 3,3 <br /> 40 Own S 14,/ss C��►^�- <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 <br /> deadlines will restart. <br /> Signed /1-4-44A/ <br /> pplicant) (Date) <br /> Signed .L '�w �'�' y <br /> ' ( wner) (Date) <br /> Page 3 of 4 <br /> Burnett County, WI Conditional Use Permit (CUP) Application—Rev 11/2019 <br />