Utility Service Communications Co

UTILITY SERVICE COMMUNICATIONS CO., INC.

535 Courtney Hodges Blvd.

P.O. Box 1350

Perry, Georgia 31069

Tel: 478-987-4663 800-679-7819

Fax: 478-987-1844

www.utilityservice.com

UTILITY SERVICE COMMUNICATIONS CO., INC.

CO-LOCATION APPLICATION

Application Date:

Application Revision Date:

CARRIER’S ON AIR TARGET DATE:

Site Owner:

Site 911 Address:

General Address or Directions:

GPS Coordinates: LT: LG:

______

Site Acquisition Firm:

Contact Name:

Address:

Office Number:

Cell Number:

Email:

Carrier:

Carrier Site ID No.:

Carrier Site Name:

Carrier Site Fixed Asset No.:

Carrier Contact Name:

Work Phone:
Cell Phone:

Fax Number:

E-Mail:

______

Carrier Project Management Co.:

Contact Name:

Work Phone:

Cell Phone:

Fax Number:

E-Mail:

______

Notes:

SITE SPECIFIC INFORMATION:

1. Frequencies:

Existing:

Transmit:

Receive:

New:

Transmit:

Receive:

2. FCC call letters:

3. Type of Service:

4. Transmitter(s):

Number:

Make:

Model:

Power Output:

ERP:

5. Receiver(s):

Number:

Make:

Model:

6. Tower Mounted Amplifiers: TMA/ODU

Number:

Make:

Model:

Dimensions:

Weight:

7. Diplexers(s):

Number:

Make:

Model:

Dimensions:

Weight:

8. Tower Mounted Remote Radio Heads/Units:

RRU / RRH / RFIG / FXFB / FXMB

Number:

Make:

Model:

Dimensions:

Weight:

Number and Size of Cable(s):

9. Remote Controlled Antenna Tilt Units: RCU/RET

Number: RCU cable must be attached to

Make: Licensees Antenna coax Run.

Make:

Model:

Dimensions:

Weight:

Number and Size of Cable(s):

10. Surge Protector(s):

Number:

Make:

Model:

Dimensions:

Weight:

Number and Size of Cable(s):

11. Antenna(s):

Number:

Make:

Model:

Type:

Dimensions:

Weight:

12. Microwave(s):

Number:

Make:

Model:

Type:

Dimensions:

Weight:

13. Coax:

Number:

Make:

Model:

Color:

Size:

14. Generator:

Type:

Size:

15. Fuel Tank:

Type:

Size:

17. Licensee’s will require Ground space measuring _’ x __’ For Licensee’s shelter or cabinets. Ground space will include grounding rings.

19.Licensee desires to obtain additional ground space measuring __’ x __’ for ______.

(Location of Licensee’s additional ground space must be approved by Licensor.)

20.All tower mounted equipment, including but not limited to: Antennas, Microwaves, Diplexers, Amplifiers, Remote Controlled Tilts, Remote Radio Heads, Junction/Distribution Boxes and Surge Protectors must be approved by Licensor.

Exact location, mounting method, height, and orientation of tower mounted equipment must be approved by Licensor.

Loose gravel is NOT permitted at the site.

Removing ______(_) antennas mounted on ___ post(s) on the____ at the ____ level.

Adding ____ (__) antennas mounted on ____ post(s) on the _____ at the ____ level, giving Licensee a total of ______antennas on ______post(s) at a maximum separation between posts of five feet in each sector.

21.Antenna Orientation:

Alpha position at degrees, on Post(s) #

Beta position at degrees, on Post(s) #

Gamma position at degrees, on Post(s) #

Scope of work relating to this upgrade:

Final Configuration:

18.Antenna mounting height, mounting orientation, and ground space usage:

Mounting method and exact location subject to review and approval by Licensor.

Loose gravel is NOT permitted at the site.

Removing ______(_) antennas mounted on ___ post(s) on the____ at the ____ level.

Alpha position at degrees, on Post(s) #

Beta position at degrees, on Post(s) #

Gamma position at degrees, on Post(s) #

TOTAL LOADING:

Requested Antenna Location:

Top of Tank ___ Balcony ___ Other ____

$2000 APPLICATION FEE DUE WITHIN 10 DAYS OF USCCI’S RECEIPT OF THIS APPLICATION.

A $500.00 site inspection fee will be required prior to the execution of a License Agreement OR PRIOR TO ISSUING A NTP.

After completion of this form, please fax to: 478-988-1844

Email to:

Debbie Sullivan @

Phone: 478-988-5255

Lee Duke @

Phone: 478-988-5260

Cristyl Smith @

Phone: 478-988-5273

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