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| Applicant Information: | |||
| Owner: | Green Mountain Realty, Corp. | Applicant Name: | |
| Site Name: | Applicant Site Name: | ||
| Applicant Address: | Applicant Site #: | ||
| Applicant City: | State and Zip: | ||
| Applicant Tel. #: | Fax: | ||
| Tower Information: | |||
| Latitude: | Existing Structure Type: | ||
| Longitude: | Existing Structure Height (AGL): | ||
| Site Address: | State and Zip: | ||
| Site City: | Fax: | ||
| Site County: | |||
| Antenna Information: | |||||
| S1 | S2 | S3 | GPS | MW | |
| Desired RAD Center (Feet AGL)*: | |||||
| Antenna Quantity - Maximum*: | |||||
| # of Lines Per Antenna: | |||||
| Diameter of Antenna Lines: | |||||
| Ground Space Requirements: | |||
| Equipment Pad Dimensions: | Shelter Dimensions: | ||
| Lease Area Dimensions: | |||
| Power Requirements: | |||
| AC Power: | Required Voltage and Total AMP: | ||
| Number of Circuits Required: | |||
| Generator Needed: | Generator Capacity Needed: | ||
| Interconnect Requirements: | |||
| Interconnect (T-1, Fiber, MW, etc.): | Required Capacity (Pairs, Mbits/Sec, etc.): | ||
| *Applicant may not install any equipment on the site. The Applicant is required to provide written confirmation of compliance with all applcable EMF radiation limits. Ifany item changes on this application, Applicant is required to resubmit corrected collocation application. |
| After
completion please mail to us at: Green Mountain Communications, Inc. 16 Lehner Street P.O. Box 356 Wolfeboro Falls, NH 03896 |