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Legal Description: <br />Lot #: CSM Vol. <br />Lot #: Block #: <br />Gov't Lot M OR 1/4 <br />OR <br />Subdivision Name: OR <br />1/4 <br />Section M Town #: N Range M. <br />W Town of: <br />*Attach additional page if needed far lengthy description OR attach a copy of the deed OR attach tax system property page. * <br />Parcel # (24 digits): (0 - -,1), � - 1- 03- COO <br />Tax ID # (1-5 digits): <br />Property Site Address: 3 6y � (��� Ck O S <br />TYPE OF PERMIT(S): Check appropriate box <br />❑ New Tower ❑ Class 1 Collocation p. Class 2 Collocation <br />Anticipated Start Date: / 6Q <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 />1"=20' or multiples of 101. 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 — 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 3/2018 <br />