Fcc Form 327 Application For Cable Television Relay Service Station License (Page 6 of 12) in pdf

APPLICATION FOR CABLE TELEVISION RELAY SERVICE STATION LICENSE

SCHEDULE C. Transmit Site Data

Fixed

Transmitter Make and Model

Second Transmitter Make and Model (if applicable)

If the structure is proposed, indicate the call sign of any AM non-directional stations

located within 1.0 km or directional AM stations within 3.0 km of the proposed structure:

Overall height above ground level (OHAGL)

OHAGL of structure without

Height of ground above mean

of structure with appurtenances (in meters):

appurtenances (in meters):

sea level (AMSL) (in meters):

Note: All geographic coordinates must be in NAD 83.

Latitude

(Circle one.)

Longitude

(Circle one.)

(dd-mm-ss.s)

North or South

(ddd-mm-ss.s)

East or West

Mode of Operation (Circle one.)

Structure Code:

Attended

Unattended

Remote Control

Mobile (See Instructions for defining service area)

Transmitter Make and Model

Second Transmitter Make and Model (if applicable)

Latitude (Northwest Corner)

(Circle one.)

Longitude (Northwest Corner)

(Circle one.)

(dd-mm-ss.s)

North or South

(ddd-mm-ss.s)

East or West

Latitude (Southeast Corner or Center of System)

(Circle one.)

Longitude (Southeast Corner or Center of System)

(Circle one.)

(dd-mm-ss.s)

North or South

(ddd-mm-ss.s)

East or West

Radius (in kilometers):

Site Information

Site Community Name

FCC Antenna Structure Registration Number

or N/A (FAA Notification not Required):

Location (street address or distance and direction outside the community)

County/Borough/Parish

State

•

If the applicant proposes construction of a major communications facility as defined in Part 1, Subpart I of the Commission’s Rules, attach as

Exhibit C-1 a statement containing the information required in Part 1, Subpart I.

•

If these facilities will be mounted on an antenna support structure previously authorized by the Commission, indicate the tower registration

number in the appropriate box of this page or include as Exhibit C-2 a statement establishing why registration is not required.

•

Construction of certain structures and alterations to structures may require notification to the Federal Aviation Administration (FAA). (See

47 C.F. R. § 17.7.) If such a notification was made and the construction or alteration is proposed, attach as Exhibit C-3 a copy of such

notification or FCC Form 854.

•

If this application may have a significant environmental effect as defined in 47 C.F.R. § 1.1307, attach as Exhibit C4 an Environmental

Assessment prescribed by 47 C.F. R. § 1.1311.

FCC 327

Approved by OMB

3060-0055

Fcc Form 327 Application For Cable Television Relay Service Station License Page 6

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