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COMMUNICATION TOWER INFORMATION FORM(CTIF) <br /> CONTACTS <br /> Property Owner's Name jj'D0d/iTPA/1;1 S <br /> Property Owner's ti/elf 614 Snide 1e'A o p r2EGon 1 war 535" )' <br /> Mailing Address Street City State ZIP <br /> Property Owner's Phone Number ( (o11 ) yes- 8/7 S <br /> Agent's Name&Affiliation ?16*t0 faxo-`e5 -Ali r 'a2 - , <br /> 141.4LA10m 4I/W F)/Op 10477'41 <br /> Agent's Relationship to Property Owner AZEN r-I�gaJvM Coa34st u,J' •r1ays <br /> Agent's Relationship to the Proposed Tower (e.g. wireless <br /> service provider,site acquisition firm,tower builder,etc.) 410.fr-strt AeawIr-ioa ez.Avr'aerolt <br /> Agent's Mailing Address /GOt •M.PjE'f C".I Wifitt xKi' Q'44' W.0 $3Z17 <br /> Street City State ZIP <br /> Agent's Phone Number ( L))if) $D 7 - 57 g 1 <br /> PROPOSED ACTION <br /> Current Zoning 4 -/ CUP Acres /‘-(4-- <br /> Proposed Zoning(only if rezoning) A - a Rezone Acres(if applicable) hr-f <br /> Have the property owner and the agent/tower sponsor formally completed a binding / es No <br /> letter of intent, option to lease, or lease? Please attach a letter from the property <br /> owner(s)consenting to the application. Circle One <br /> Yes No <br /> If applicable,does the lease area coincide with the proposed CUP area? <br /> Circle One <br /> LOCATION <br /> Town 1 uTLAtJ0 <br /> PLSS location(Township,Range, '/4''A Section) L yZ e$ //Z 6F /l)E%y $31 -r51-) R )a` <br /> Parcel Number(s) O 510 7'11 "re"-1 `l 05-10-31/1-S150-0 <br /> o )D 1L11 - 150-0 <br /> Street Address(or Proximity to Nearest Address) 3 7 (, g Oa) S7X 4r ,Q.oiAJ) <br /> Coordinates in Decimal Degrees <br /> (00.000000 Lat.,-00.000000 Long.) Lia ,&5 LIZ&q '9, Zel'1-33 <br /> Is the subject property located in the Height Limitation Zoning Overlay District (HLZO), Yes (No) <br /> roughly within three miles of the Dane County Regional Airport(check with Zoning staff)? Circle One <br /> H:\Zoning\Zoning Division Documentation\Informational Materials\Communication Towers\Communication Tower Application <br /> Packet 09-2010.doc <br /> Page 6 of 10 <br /> 210 Martin Luther King Jr.Blvd.❖Room 116,City-County Bldg.❖Madison,WI 53703-3342+Phone:608.266.4266❖Fax:608.267.1540 <br />