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<br /> 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 /> co, id. those that only touch at a common property corner. Address for the owner would be their mailing address(where they get
<br /> t eir mail) in many cases, this may not be the site address. Attach additional sheets if necessary.
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<br /> 4150 gu/^• ropose uildin str ct� Ateonsmutib toed ��o submitti733?
<br /> g this application 733
<br /> � p gto the /��g
<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 /> S r • 173w 3y/78
<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 hfaaring agenda and the submittal deadlines will restart.
<br /> v D � TS
<br /> P / SZ�
<br /> • HIS APPL AION CONSTITUTES NOTICE THAT ALL IMPROVEMENTS ARE
<br /> SUBJECT
<br /> TO ACCESS AND/OR REVIEW BY THE LOCAL MUNICPALITY'S TAX ASSESSOR FOR
<br /> l$ t'otaH T ve 54,4it 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 g t (Date)
<br /> ant
<br /> ---- ;Signed - 17 J E-02_0
<br /> (
<br /> wner) (Date)
<br /> Page 3 of 4
<br /> Burnett County, WI Conditional Use Permit(CUP)Application —Rev 11/2019
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