Cell Site Permit Application

Cell Site Permit Application

WHEREAS

WHEREAS, Applicant: seeks authorization to install, operate, and maintain communications equipment and related improvements at the proposed site described below; and

WHEREAS, Property Owner / Authorizing Entity: has authority to permit use of the site and may impose conditions to protect public safety, visual character, and property interests; and

WHEREAS, Applicant requests a permit to locate telecommunications facilities at the site in accordance with applicable laws, standards, and the terms set forth in this application and any resulting permit.

APPLICANT INFORMATION

SITE LOCATION & PROPERTY DETAILS

Parcel/Tax ID:    Zoning Designation:

SCOPE OF WORK

Tower/Structure Type:    Height Above Ground (ft):

TECHNICAL & ENVIRONMENTAL INFORMATION

RF Emissions Study Provided:    Structural Analysis Provided:    Visual Simulation Provided:

ATTACHMENTS CHECKLIST

Site Plan showing proposed location and setbacks
Structural Analysis and Elevations
RF Emissions Study
Proof of Insurance and Indemnity Agreement
Lease / Landowner Consent / Easement Documentation

PAYMENT TERMS

Application Fee Amount: $    Payment Schedule:

Late Payment Fee: . Applicant acknowledges permit processing may be suspended until fees are paid in full.

TERM AND TERMINATION

Proposed Permit Term: Commencement Date: — Expiration Date: .

Termination: Either party may terminate for material breach after providing written notice of breach and days to cure. Emergency termination for public safety may be immediate upon written notice.

CONFIDENTIALITY

Applicant acknowledges that records submitted in connection with this application may be public records subject to disclosure under applicable law. Proprietary technical materials marked confidential will be treated as confidential to the extent permitted by law; the determining authority shall notify Applicant prior to disclosure so Applicant may seek protective measures at its expense.

CERTIFICATIONS, INDEMNITY AND COMPLIANCE

By submitting this application, Applicant certifies that all information provided herein is true and correct to the best of Applicant’s knowledge; Applicant will comply with all local, state, and federal laws and regulations applicable to construction and operation of telecommunications facilities; and Applicant shall defend, indemnify, and hold harmless the Property Owner and Authorizing Entity from any claims, damages, or liabilities arising from Applicant’s installation, operation, maintenance, or removal of the facilities, except to the extent caused by the gross negligence or willful misconduct of the indemnified party.

GOVERNING LAW

This application and any permit issued pursuant to it shall be governed by and construed in accordance with the laws of the jurisdiction in which the site is located. Applicant submits to the exclusive jurisdiction of the courts located within that jurisdiction for purposes of any action arising out of or related to this application or permit.

ENTIRE AGREEMENT

The terms contained in this application, together with any permit conditions, attachments, plans, and executed agreements incorporated by reference, constitute the entire understanding between Applicant and the Authorizing Entity regarding the subject matter hereof, superseding all prior negotiations and representations.

APPLICATION ACKNOWLEDGEMENTS

Applicant acknowledges that submission of this application does not constitute authorization to proceed with construction. No work shall commence until a written permit has been issued and all required fees, bonds, and insurance are in place. Permit issuance may be conditioned upon additional mitigation measures, inspection schedules, or technical modifications to ensure public safety and compliance.

ADDITIONAL INFORMATION

DECLARATION

I hereby declare under penalty of perjury that the information provided in this application and accompanying documents is true and complete. I understand that false statements may be grounds for denial or revocation of any permit and for civil or criminal penalties.

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