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COMMUNICATION TOWER INFORMATION FORM(CTIF) <br /> CONTACTS <br /> Property Owner's Name Don Squire, Jr. <br /> Property Owner's 2046 Norgaren Rd Stoughton WI 53559 <br /> Mailing Address Street City State ZIP <br /> Property Owner's Phone Number ( 608 ) 873-4663 <br /> Agent's Name&Affiliation Nathan Ward, Buell Consulting <br /> Agent's Relationship to Property Owner Tenant ' s agent <br /> Agent's Relationship to the Proposed Tower (e.g. wireless <br /> service provider,site acquisition firm,tower builder,etc.) Site Acquisition Specialist <br /> Agent's Mailing Address 1200 Riva Ridge Racine WI 53402 <br /> Street City State ZIP <br /> Agent's Phone Number ( 414 1 788-1327 <br /> PROPOSED ACTION <br /> Current Zoning A2 CUP Acres .23 <br /> Proposed Zoning(only if rezoning) Rezone Acres(if applicable) <br /> Have the property owner and the agent/tower sponsor formally completed a binding 411110 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 /> No <br /> If applicable,does the lease area coincide with the proposed CUP area? <br /> Circle One <br /> LOCATION <br /> Town Pleasant Springs <br /> PLSS location(Township,Range, ''A ''A Section) 27/06/11 <br /> ParcelNumber(s) 046/0611-271-8730-0 <br /> SE Corner of Cty. B & Spring across <br /> Street Address(or Proximity to Nearest Address) <br /> from 2095 S•rin• Road <br /> Coordinates in Decimal Degrees <br /> (00.000000 Lat., 00.000000 Long.) <br /> 42 . 962569 Lat , -89 . 179725 Long <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)? <br /> Circle One <br /> H:\Zoning\Zoning Division Documentation\Informational Materials\Communication Toy,ers\Communication Tower Application <br /> Packet 09-2010.doc <br /> Page 6 of 10 <br /> 210 Martin Luther kin0 Jr.Blvd.•:•Room 116,City-County Bldg.•:•Madison,AVI 53-03-31-12•11 Ph•rt•608266.}266❖hav 60S.26-.1540 <br />