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DocuSign Envelope ID: 454AC100- 1926- 4795- B94B- 86B8B3246CC0 <br />tiC1�l� i?�y <br />i'I Idt�loi "i`' t matt: =�F( ila1��1 f9Bt•t,(tal�� <br />Commercial Wireless Provider: Mueller Systems, LLC <br />Personal Wireless provider: Click Mere to enter text. <br />Latitude (NAD83): 35,95972659 <br />Ground Elevation (AMSL) (ft): 524ft <br />Center of Signal Radiation — RAD Center (ft): N/A <br />FCC Antenna Structure Registration Number (ASR) <br />(if applicable): <br />N/A <br />New Structure: Yes 0 No ❑ Co- location: Yes ® No ❑ <br />Replace Existing Structure: Yes ❑ No X <br />New Concealed Attached Facility: Yes ❑ No 0 <br />Modified Concealed Facility structure: Yes ❑ No <br />Longitude (NAD83): - 79.07770773 <br />Total Height of Structure (AGL) (ft) <br />40 <br />Co- attached: Yes f_l No M Water Tower: Yes ❑ No <br />Replacement (upgrade) of existing antennas: Yes ❑ No <br />New Concealed Antenna Support structure: Yes ❑ No 0 <br />In Right -of -Way; Yes ❑ No N <br />Net Land Area (NLA): Area within zoning lot boundaries <br />NLA = <br />5 <br />sq. ft. <br />Choose one, or both of <br />the following (a or b), not <br />to exceed 10% of NLA <br />a) Credited Street Area (total adjacent frontage) x % width of public right- <br />of -way <br />CSA = <br />0 <br />sq. ft. <br />b) Credited Permanent Open Space (total adjacent frontage) x Y2 public or <br />dedicated open space <br />COS = <br />0 <br />sq. ft. <br />TOTAL: NLA + CSA and /or COS = Gross Land Area (not to exceed NLA + 10%) <br />GLA = <br />5 <br />sq. ft. <br />Special Protection Areas: (check all those that apply) <br />Jordan Buffer ❑ Resource Conservation District ❑ 100 Year Floodplain ❑ Watershed Protection District <br />Land Disturbance <br />Total (sq ft) <br />Area of Land Disturbance (Includes: footprint of proposed activity plus work area envelope, staging area for materials, <br />access /equipment paths, and all grading, Including off -site clearing) <br />50 <br />Area of Land Disturbance within RCD <br />0 <br />Area of Land Disturbance within Jordan Buffer <br />0 <br />Impervious Areas <br />Existing (sq ft) <br />Demolition (sq ft) <br />Proposed (sq <br />ft) <br />Total (sq ft) <br />Impervious Surface Area jISA) <br />0 <br />0 <br />0 <br />0 <br />Page 2 of 3 <br />