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4 <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` those that only touch at a common property corner. Address for the owner would be their mailing address(where they get <br /> L their mail)in many cases, this may not be the site address. Attach additional sheets if n'cessary. <br /> 44 <br /> Ads,/ OM a /ll ( '0 , "I �r y i 1/1 IP -- •.,II. .- - <br /> iO%3 Lin t. Serve tl (ibs/ c . 'c) , b, tdek tt,' Ss' 53 <br /> ® 10961f Je•f4 SAeeR �I►ntaer 9Y t .2-Lb (Akin. i LAS <br /> 5/0919- rl,'lr,�,vll y ��a" 4 t5 w‘ 2 14 00 Re/ ttt�'aH a Gv S g'P <br /> 0lio8gC3ame� ( 6.1 fle rse 9'i`z7 Cowt4 Alb w s� i t st,8.93 <br /> ZAlfric1 �lie -7/Y9'f /f AS /�s�i /a1 NA) S'S'z3 <br /> �l o q�olo 7 Se s <br /> (v ow&A of G-i;tic-0/14 Ch k — <br /> P 'uth • Proposed building/structure locations must be staked prior to submitting this application to the <br /> � Ap Land Services Department. County staff will do an onsite visit to verify site conditions. If site is <br /> a‘" 7P not staked upon Countystaff visit this application will be returned to the applicant. Returned <br /> T� I� P PP <br /> '`1'p application will result in the item being removed from the hearing agenda,and the submittal <br /> Ideadlines will restart. <br /> ��_si • If all existing structures are not shown and dimensioned on the plot plan drawing the application <br /> 0 p will be returned to the applicant. Returned application will result in the item being removed from <br /> a the hearing agenda and the submittal deadlines will restart. <br /> V'n <br /> 1zl l7• 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 /> _ciZirl::: <br /> Sign:. rt Q <br /> Applicant) (Date) <br /> �. =.�c�`,ci <br /> Si: __ _`.►_tom /1 <br /> ( .- iv% (Owner_) 2 = ate) <br /> /0 9 Page 3of4 <br /> Burnett County, WI Conditional Use Permit(CUP)Application—Rev 11/2019 <br />