Verizon 320262- Mcleod_Creek- ATC 280360- Palmetto Dr NC- Harnett County NC- Communications Collo App (Zoning)Harnett County North Carolina Communications Facility
Collocation Application Checklist
HCWFC-04
Date Submitted: ____________________________
APPLICANT’S NAME: ________________________________________________________________________________
Phone: _______________________ FAX: _____________________ E-mail: _____________________________
PROPERTY OWNER: _______________________________________________Phone: ___________________________
APPLICANT'S CONTACT: ____________________________________________________________________________
Address____________________________________________________________________________________
Phone: _______________________ FAX: _____________________ E-mail: _____________________________
Lessor/Licensor Contact Information:
Name: ______________________________________________________________________________________
Address: ___________________________________________________________________________________
Phone: _______________________ FAX: ______________________ E-mail: ____________________________
Commercial Wireless Provider ________________________________________________________________
New Structure: Yes [ ] No [ ] Co-location: Yes [ ] No [ ] Water Tower: Yes [ ] No [ ]
Replace Existing Structure: Yes [ ] No [ ] Replacement (upgrade) of existing antennas Yes [ ] No [ ]
Stealth Attached Facility: Yes [ ] No [ ] New Stealth Antenna Support Structure: Yes [ ] No [ ]
FACILITY INFORMATION:
Site Address: _______________________________________________________________________________________
Latitude (NAD83): _________________________________Longitude (NAD83): _________________________________
Ground Elevation (AMSL) (ft): _______________________Total Height of Tower: (AGL) (ft) ______________________
RAD Center (ft): _____________________________________________________________________________________
TAX Parcel Identification Number: _____________________________________________________________________
Present Zoning of Property: __________________________________________________________________________
Land Use and Description of Property: _________________________________________________________________
FCC Antenna Structure Registration Number (ASR) (if applicable): __________________________________________
The following must be enclosed with this application:
1. A complete set of construction drawings of the proposed facility demonstrating compliance with applicable
Federal, State and Harnett County building codes; and,
2. A structural analysis by a Registered Professional Engineer that the support structure complies with
applicable ANSI/EIA/TIA-222G (as amended) standards; and,
3. A statement (electronic preferable) from a qualified individual that the applicant will comply with all FCC
rules regarding human exposure to RF energy and a statement (electronic preferable) from the applicant
that the applicant will comply with all applicable FCC rules regarding radio-frequency interference;
Please Note: Supplemental information may be requested for purposes of clarity or confirmation.