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-ONDITIONAL USE PERMIT (CUP) APPLICATION — Burnett County, WI <br /> $300.00 CONDITIONAL USE #: CUP-19- 2 y ZONING DISTRICT: -z- <br /> /� RA CEL # (24digits): 67-o.12-Z-�41-/6-3S-S JS-O`f�9�o13000 <br /> Zs RECEIVE <br /> TAX ID #: Z S3 D <br /> Burnett County <br /> ��` Lund Services Department <br /> LAND SERVICES STAFF ONLY ABOVE THIS LINE &� =17 $,3L-1-> <br /> Applicant Complete All Sections Below This Line <br /> Property Owner's Name: SN Q, J tV1 berI k� <br /> Applicant's Name: gcog, a6 g,4g, <br /> Applicant's Mailing Address: <br /> Q (��/n�✓' City State Zip <br /> Applicant's Telephone Number: I �' - /(raj <br /> Applicant's Email: � �'yL��I' crifL <br /> If staff has a question about this application,how do you prefer to be contacted? Check one below: <br /> ❑ Letter ❑Phone 0 Email <br /> Legal Description: ,e ' t eG 3 J o l t f l o <br /> Lot#: C M Vol. Pg. OR Q, V / <br /> Lot#: Block#: Subdivision Name: NA S OR <br /> Gov't Lot#: OR 1/4 1/4 <br /> Section#: '3-5- Town#: L_ Range#:�W Town of: .5ti ,SS <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> Parcel#(24 digits): 00 <br /> 2 .- '~ '®1 <br /> Tax ID#(1-5 digits): 0 <br /> Lot Area: �WX 5ah/x fc 0j' ftZ and L acres <br /> Property Site Address#: Zq-71 r%rd r UA& b u N <br /> Anticipated Start Date:i <br /> Section#of the Ordinance this CUP is referencing: <br /> Page 1 of 4 <br /> Burnett County,WI Conditional Use Permit(CUP) Application-Rev 1/2019 <br />