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I (applicant) hereby make application tot a Lanq Use aqdnformation C}f}9r a CQnditi9 A Use Permit (CUP) <br />for the following: �J'1.2 Via r �ommitee <br />Q 1'' l� 7, L_Q /"N <br />li,AW Sa-YLi�-C ."� l./S'4?-ln <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'. Note the scale used on the drawing. Plot plan drawing shall be on letter <br />or legal size paper with North being at the top of the page. (Make sure all items below are 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 3/2018 <br />