Macon County Telecommunications Tower Annual Renewal Permit Application Form

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MACON COUNTY TELECOMMUNICATIONS TOWER
ANNUAL RENEWAL PERMIT APPLICATION
Application/Job(Site) Number: _____________________________ Parcel ID Number: _________________
Permit Number:_______________ Date Issued: ____________ Type of Permit: ___________________
Telecommunication Tower Contact Information
Name: __________________________________________________________________________________________________________
Address: _________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
Phone: _____________________________ Fax: __________________________ E-Mail: ________________________________________
Co-Location Contact Information (subsequent telecommunication companies on site)
Name: _________________________________________________________________________________________________________
Address: ________________________________________________________________________________________________________
________________________________________________________________________________________________________________
Phone: _____________________________ Fax: __________________________ E-Mail: _______________________________________
Name: __________________________________________________________________________________________________________
Address: _________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
Phone: _____________________________ Fax: __________________________ E-Mail: ________________________________________
Lessor Contact Information
Name(s): _________________________________________________________________________________________________________
Address: __________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Phone: ___________________________ Fax: __________________ E-Mail: __________________________________________________
APPLICANT'S CERTIFICATIONS
The applicant represents and certifies that the following are true and accurate:
The applicant has not constructed, maintained, operated or modified any wireless telecommunication facility within Macon County without
the approval of Macon County, or, if it has constructed, maintained, operated or modified any wireless telecommunication facility within
Macon County without the approval of Macon County, that if has ceased operating and has removed all above-ground portions of such
facilities ( not including any part of the foundation)______(initial).
The proposed wireless telecommunication facility complies with, all applicable FCC rules and regulations with respect to environmental
effects of electromagnetic emissions_______(initial).
Any telecommunication tower to be constructed as part of the proposed wireless telecommunication facility is not required to be lighter or
painted by rules and regulations of the Federal Aviation Administration________(initial).
All improvements constructed as part of the wireless telecommunication facility shall comply with the Uniform Building Code, National
Electrical Code, Uniform Plumbing Code, Uniform Mechanical Code, Uniform Fire Code, and structural standards of the Electronic
Industries Association/Telecommunications Industry Association, where applicable_________(initial).

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