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I(applicant)hereby make application to the Land Use and Information Committee for a Conditional Use Permit(CUP) <br /> for the following: 7/.4 .-s .‘e S—C9 yea <br /> fS <br /> .✓e//>C /��c/R e`s c",J 77� s� �`� c� ase- rte/ <br /> L7'c Ccit�1-i�,�c5 G 1c , C.t _)C-4-7;"1I" i <br /> 1/4_1.5O r J r [Slr�✓ T S C l�� ( C�.�— I tS�c/C S� L.tc <br /> A plot plan drawing is required. Plot plan shall be drawn with a scale preferably at 1"=20' or multiples of <br /> 10',scale shall not exceed 1"=50',unless approval from Zoning Administrator for a different scale is <br /> allowed. Note the scale used on the drawing. Plot plan drawing shall be on letter or legal size paper with <br /> North being at the top of the page. (Make sure all applicable items below are shown, this general application <br /> might not require all items below): <br /> ❑ Property lines,road right-of-ways,and road centerlines including distances to property lines,road right-of-ways and <br /> road centerlines for all existing and proposed structures on the parcel <br /> ❑ Show area to used for the proposed Conditional Use <br /> ❑ All existing uses on parcels adjacent to the parcel for this request <br /> ❑ All existing zoning districts on parcels adjacent to the parcel for this request <br /> ❑ Vegetation proposed to be removed or disturbed <br /> ❑ Ordinary High Water Mark(OHWM)and distances to it from all existing and proposed structures;must show all <br /> within 200 ft of structures <br /> ❑ Floodplain and wetland boundaries and distances to them from all existing and proposed structures;must show all <br /> within 200 ft of structures <br /> ❑ Dimensions,locations and setbacks of all existing and proposed structures including all <br /> decks/porches/walkways/etc;must show dimensions for ALL items <br /> ❑ Existing and proposed utilities and utility easements <br /> ❑ Sanitary system,drainfield and well with distances to property lines,OHWM,wetlands,floodplains,existing and <br /> proposed buildings <br /> ❑ Location and extent of filling/grading <br /> ❑ Location and type of erosion control measures <br /> ❑ Any other construction related to your project <br /> ❑ North arrow <br /> Page 2 of 4 <br /> Burnett County, WI Conditional Use Permit (CUP)Application—Rev 1/2021 <br />