Communication Site Technical Data Report - U.s. Department Of The Interior
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1
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3UNITED STATES DEPARTMENT OF THE INTERIOR
BUREAU OF LAND MANAGEMENT
COMMUNICATION SITE TECHNICAL DATA REPORT
1.Name and address of applicant
2.Right of way
3. State
4. County
Facility Type
5. Resource Area
6. District
7. Elevation
8. Legal description and site name
9. Latitude and longitude
Case file number:
10. Type of applicant
a. _____ Individual
d. ______ State
b. _____ Corporation*
e. ______ Local government
c. _____ Partnership/Association
f. ______ Federal
11. Name, address, and telephone number of emergency contact person(s)
Communication Site telephone number
12. Power source
a. ______ commercial
c. ______ Wind w/Battery
e. _____ Other (explain)
b. ______ solar w/battery
d. ______ Battery only
Stand by power _____
Type
13. Type of operational control planned:
a. ______ Local control
c. ______ Automatic Repeater
b. ______ Wire Control
d. ______ Radio link Remote
14. Repeater tone protected: ______ Yes
_______ No
15. Antenna Mounting Structure:
_______Wooden
________ Steel Tower
Height above ground
________
_______ Treated
Mfg__________________
Dia of pole or Tower ________
_______ Number Planned
Model No. ___________
Distance from Bldg
________
Number Planned ______
Space for other Users________
Please provide a copy of the site construction plan showing a landscape view and aerial view
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Parent category: Legal