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I (applicant) hereby make application to the Land Use and Information Committee for a Conditional Use Permit <br /> (CUP)for the following: <br /> 12!r-k a 57th i yWel <br /> A plot plan drawing is required. Plot plan shall be drawn with a scale preferably at 1"=20' or multiples of <br /> 101. Scale shall not exceed 1"=501. Note the scale used on the drawing. Plot plan drawing shall be on <br /> letter,legal or ledger size paper with North being at the top of the page. (Make sure all items below are <br /> shown): <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 1/2016 <br />