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Provide names and addresses of all adjoining property owners. <br /> *Ad joiners 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 9 1$'r1 <br /> heir mail) in many cases, this ay not be the site address. Attach additional sheets if n cessary. �'1 <br /> ,l.G%'� - d ;e + :r..f ill -% <br /> v 0 6/-1e3/IW N6.4fr `- J' 'n e in6 ?4 1)t iii ' a metJ A/ `Cs-'136 <br /> ✓© -" # ,i4 - ii z .3 6*. &A',441d A ( �� 4i <br /> ,�. .3 is' <br /> d , k `ef '�-/ / -433 ,5)L -i -- ,4�, ld.✓d, i 6 1 <br /> 2d a4d/eji(S �, leY!, - ?/o/ li/���,////4 2A/i/K,�I �;646/1 610-A' <br /> - I OM 33o 1- 5* D3 <br /> -fiq i'I : 33°'( - HvenN/ 3yoY1f�- bec /' 33V— /Amp <br /> 33 1-/1 lIe qi 3317 SkAilk_ 323(0 - 1410100p <br /> VC) Th4lirrATii Su not hG &c Ilex-- li f 2q9 55-t ` ' 'V A* Me tieJ7'4 iviAj cco8 _ <br /> 9 • , of flew el - Cl t.4- <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. [ 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 submitta •adlines will restart. <br /> c • <br /> Signed / G9� �J <br /> t � ii co 7 / o <br /> (Applicant) (Date) <br /> / <br /> j ; <br /> Signed L.t���� // l /l u q///%' ICG <br /> (Owner) (Date) <br /> Page 3 of 4 <br /> Burnett County, WI Conditional Use Permit (CUP) Application —Rev 11/2019 <br />