"Polk County Tower Application" - Polk County, Wisconsin

Polk County Tower Application is a legal document that was released by the Wisconsin Department of Safety and Professional Services - a government authority operating within Wisconsin. The form may be used strictly within Polk County.

Form Details:

  • Released on April 26, 2016;
  • The latest edition currently provided by the Wisconsin Department of Safety and Professional Services;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Wisconsin Department of Safety and Professional Services.

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Download "Polk County Tower Application" - Polk County, Wisconsin

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Polk County Tower Application
POLK COUNTY TOWER APPLICATION
Use "Tab" key to move between fields
Make check (black ink) payable to:
Print Form
Mail in with fee - see table below
Polk County Zoning Department
COMPLETE ALL UNSHADED AREAS
MAKE CHECKS (black ink) PAYABLE TO:
Incomplete applications may be returned
100 Polk County Plaza, Suite 130
INCOMPLETE APPLICATIONS MAY BE RETURNED
Polk County Zoning Department
Erase Form
Balsam Lake, WI 54810
PLEASE PRINT – BLACK INK & RETURN ORIGINAL FORM
100 Polk County Plaza, Suite 130
(715) 485-9111, Mon-Fri, 8:30am-4:30pm
Balsam Lake, WI 54810
Property Address (Number & Street or Ave)
715-485-9111, Mon- Fri, 8:30am-4:30pm
Leasing Agent, Contractor, builder, OR Self
Property
Owner __________________________________________________________
Address
Mailing
Address _________________________________________________________
City
State
Zip
City _____________________________ State ________ Zip _____________
Phone Number
Mail permit to Contractor
Email
(optional):_______________________________________________________
Yes
No
Phone Number:
__________________________________________________
PERMIT REQUESTED FOR: Fill in appropriate line
This
New Tower Fees:
New Tower
Permit Number
Fee: $
(includes address fee)
120’ or less
$500
column for
Collocation on Tower
Permit Number
Fee: $350
121’ to 160’
$1200
office use
(includes ground equipment)
160’ to 200’
$2100
only
Modify Transmission Facility
Permit Number
Fee: $350
200’ & up
$3000
LEGAL DESCRIPTION OF PROPERTY – SEE TAX BILL
Gov’t Lot
Parcel # / Computer #
Lot #
Subdivision/CSM #
___ ___ ___ - ___ ___ ___ ___ ___ - ___ ___ ___ ___
__________ ¼ __________ ¼, Sec __________ / T _________N /R _________ W
Town of __________________________________
Size of parcel
Size of lease parcel (If applicable)
OR
OR
X
=
SQ FT
Acres
X
=
SQ FT
Acres
ADDITIONAL INFORMATION
Height of Tower
Cost of Project
Type of road your driveway is off of:
Name of Lake/Pond/River/Flowage
Collocation Available:
 US or State Hwy
 County Rd
$
 Town Rd
 Private Rd
 Yes 
No
Property Line Setback- 100% of the height of the tower- Unless an engineering report is provided by a professional
engineer that certifies that the tower is designed to collapse in the distance from the proposed tower location to the
property line.
Please provide one copy of the structural analysis and construction plans along with the other requirements of the
Telecommunication Towers, Antennas, and Related Facilities Ordinance with your application and fee.
Check with the town and other regulating agencies for additional regulations, permits or licensing that may be required.
The applicant, as witnessed by the applicant’s signature on this application hereby attests that the information contained therein and
any accompanying documents are accurate and true. Any assistance by County staff was at the applicant’s request. I agree to permit
county officials charged with administering county ordinances or other authorized person to have access to the above-described
premises at any reasonable time for site review.
Signature
Sign Here: ___________________________________ Date: _______________ □ Cash □Credit □ Check # _______
COMMENTS:
Office Use Only
Receipted/Issued by: ________________________________________
Date: ________________ Fee ________________
Date Received
Flood Plain
Zoning District
Runoff Rating
Lake Classification
 Yes 
No
 Yes 
No
1
2
3
Revised 4/26/2016
1 of 1
Polk County Tower Application
POLK COUNTY TOWER APPLICATION
Use "Tab" key to move between fields
Make check (black ink) payable to:
Print Form
Mail in with fee - see table below
Polk County Zoning Department
COMPLETE ALL UNSHADED AREAS
MAKE CHECKS (black ink) PAYABLE TO:
Incomplete applications may be returned
100 Polk County Plaza, Suite 130
INCOMPLETE APPLICATIONS MAY BE RETURNED
Polk County Zoning Department
Erase Form
Balsam Lake, WI 54810
PLEASE PRINT – BLACK INK & RETURN ORIGINAL FORM
100 Polk County Plaza, Suite 130
(715) 485-9111, Mon-Fri, 8:30am-4:30pm
Balsam Lake, WI 54810
Property Address (Number & Street or Ave)
715-485-9111, Mon- Fri, 8:30am-4:30pm
Leasing Agent, Contractor, builder, OR Self
Property
Owner __________________________________________________________
Address
Mailing
Address _________________________________________________________
City
State
Zip
City _____________________________ State ________ Zip _____________
Phone Number
Mail permit to Contractor
Email
(optional):_______________________________________________________
Yes
No
Phone Number:
__________________________________________________
PERMIT REQUESTED FOR: Fill in appropriate line
This
New Tower Fees:
New Tower
Permit Number
Fee: $
(includes address fee)
120’ or less
$500
column for
Collocation on Tower
Permit Number
Fee: $350
121’ to 160’
$1200
office use
(includes ground equipment)
160’ to 200’
$2100
only
Modify Transmission Facility
Permit Number
Fee: $350
200’ & up
$3000
LEGAL DESCRIPTION OF PROPERTY – SEE TAX BILL
Gov’t Lot
Parcel # / Computer #
Lot #
Subdivision/CSM #
___ ___ ___ - ___ ___ ___ ___ ___ - ___ ___ ___ ___
__________ ¼ __________ ¼, Sec __________ / T _________N /R _________ W
Town of __________________________________
Size of parcel
Size of lease parcel (If applicable)
OR
OR
X
=
SQ FT
Acres
X
=
SQ FT
Acres
ADDITIONAL INFORMATION
Height of Tower
Cost of Project
Type of road your driveway is off of:
Name of Lake/Pond/River/Flowage
Collocation Available:
 US or State Hwy
 County Rd
$
 Town Rd
 Private Rd
 Yes 
No
Property Line Setback- 100% of the height of the tower- Unless an engineering report is provided by a professional
engineer that certifies that the tower is designed to collapse in the distance from the proposed tower location to the
property line.
Please provide one copy of the structural analysis and construction plans along with the other requirements of the
Telecommunication Towers, Antennas, and Related Facilities Ordinance with your application and fee.
Check with the town and other regulating agencies for additional regulations, permits or licensing that may be required.
The applicant, as witnessed by the applicant’s signature on this application hereby attests that the information contained therein and
any accompanying documents are accurate and true. Any assistance by County staff was at the applicant’s request. I agree to permit
county officials charged with administering county ordinances or other authorized person to have access to the above-described
premises at any reasonable time for site review.
Signature
Sign Here: ___________________________________ Date: _______________ □ Cash □Credit □ Check # _______
COMMENTS:
Office Use Only
Receipted/Issued by: ________________________________________
Date: ________________ Fee ________________
Date Received
Flood Plain
Zoning District
Runoff Rating
Lake Classification
 Yes 
No
 Yes 
No
1
2
3
Revised 4/26/2016
1 of 1