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Legal Description: <br /> Lot#: CSM Vol. Pg. OR <br /> Lot#: Block#: Subdivision Name: OR <br /> J <br /> Gov't Lot#: OR W 1/4— SE 1/4 <br /> Section#: 10 Town#: 3�N Range#:_/j&_W Town of. N1)FEjv n/✓ <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): <br /> Tax ID#(1-5 digits): Q�P��JQ 0 <br /> Property Site Address#: DV <br /> Road Name: CQIA✓I � Ff— City: � 5 <br /> TYPE OF PERMIT(S): Check appropriate box <br /> J New Tower ❑ Class 1 Collocation Class 2 Collocation <br /> Anticipated Start Date: " /,30 / <br /> A plot plan drawing is required to be submitted along with this application. Plot plan shall be drawn with a scale preferably at <br /> V=20'or multiples of 10'. Scale shall not exceed 1"=50'. Note the scale used on the drawing. Plot plan drawing shall be on letter, <br /> legal or ledger size paper with North being at the top of the page. (Make sure all items below are shown—check each box): <br /> ❑ Property lines,road right-of-ways,and road centerlines including distances to property lines,road right-of-ways,and road <br /> centerlines for all existing and proposed structures on the parcel <br /> ❑ Ordinary High Water Mark(OHWM)and distances to it from all existing and proposed structures;must show all within 200 ft of <br /> structures <br /> ❑ Floodplain and wetland areas/boundaries and distances to them from all existing and proposed structures;must show all within 200 <br /> ft of structures <br /> ❑ Proposed structures and their proposed locations including all decks/porches/walkways/etc;must show dimensions for ALL items <br /> ❑ Proposed sanitary system,drainfield,and proposed well location including distances to property lines,road right-of-ways,and road <br /> centerlines <br /> ❑ Existing structures on the parcel including all decks/porches/walkways/etc and including any existing sanitary system,drainfield, <br /> and wells;must show dimension for ALL items <br /> ❑ Heights for all existing and proposed structures *Height is measured from lowest adjacent grade to the highest roof peak and <br /> to the highest point of the tower <br /> ❑ Existing and proposed parking(Commercial/Industrial Only);must show dimensions,width,and proposed number of stalls <br /> *List continues on next page <br /> Page 2 of 5 <br /> Burnett County,WI Tower Application—Rev 3/2015 <br />