COLLOCATION APPLICATION Type of Application New Lease Amendment Date NCN SITE INFORMATION NCN Site Name NCN Site Number NCN Site Address Latitude Longitude Type ---BuildingCasinoLight PoleOtherShopping MallSign PoleSports Venue CARRIER INFORMATION Carrier Site Name Carrier Site Number Carrier Legal Entity Name State of Registration Type of Entity ---LLCCorpGen PartOtherS CorpSole Prop Carrier NOC Notice Address Copy to Signatory Name Signatory Title Leasing Contact Leasing Contact Number Leasing Email Construction Contact Construction Contact Number Construction Email FREQUENCY INFORMATION TX RX Licensed Yes Unlicensed Yes Technology Type ---3G4GCMDALTEMWOTHERTVWIFI Antenna Gain EIRP TX Power Output Electrical Service Required Power Type ---AC/DCAmpsVoltsWatts GROUND/ROOFTOP/INTERIOR LEASED RIGHTS Total Area Dimensions Total SF Ground Yes Rooftop Yes Interior Yes Pad Dimensions Width Pad Dimensions Height Cabinet Dimensions Width Cabinet Dimensions Height Shelter Dimensions Width Shelter Dimensions Height CabinetShelter Weight Number of batteries Model of Batteries Generator Yes Yes Generator No Yes Fuel Type ---DieselNatural GasOtherPropane Size Pad Width Pad Height EQUIPMENT LEASED RIGHTS Type Qty Location or Height Mount Manufacturer Model Weight Dimensions Azimuth ---Bias TCombinerDi/TriplexerIce ShieldJunction BoxMWOmni/WhipPanelRETRRUSurgeTMAWisp ---FacadeGroundOtherRoof ---BaseChimneyFlushInvertedRoofStealthTopUpright ---Bias TCombinerDi/TriplexerIce ShieldJunction BoxMWOmni/WhipPanelRETRRUSurgeTMAWisp ---FacadeGroundOtherRoof ---BaseChimneyFlushInvertedRoofStealthTopUpright ---Bias TCombinerDi/TriplexerIce ShieldJunction BoxMWOmni/WhipPanelRETRRUSurgeTMAWisp ---FacadeGroundOtherRoof ---BaseChimneyFlushInvertedRoofStealthTopUpright ---Bias TCombinerDi/TriplexerIce ShieldJunction BoxMWOmni/WhipPanelRETRRUSurgeTMAWisp ---FacadeGroundOtherRoof ---BaseChimneyFlushInvertedRoofStealthTopUpright ---Bias TCombinerDi/TriplexerIce ShieldJunction BoxMWOmni/WhipPanelRETRRUSurgeTMAWisp ---FacadeGroundOtherRoof ---BaseChimneyFlushInvertedRoofStealthTopUpright ---Bias TCombinerDi/TriplexerIce ShieldJunction BoxMWOmni/WhipPanelRETRRUSurgeTMAWisp ---FacadeGroundOtherRoof ---BaseChimneyFlushInvertedRoofStealthTopUpright ---Bias TCombinerDi/TriplexerIce ShieldJunction BoxMWOmni/WhipPanelRETRRUSurgeTMAWisp ---FacadeGroundOtherRoof ---BaseChimneyFlushInvertedRoofStealthTopUpright ---Bias TCombinerDi/TriplexerIce ShieldJunction BoxMWOmni/WhipPanelRETRRUSurgeTMAWisp ---FacadeGroundOtherRoof ---BaseChimneyFlushInvertedRoofStealthTopUpright ---Bias TCombinerDi/TriplexerIce ShieldJunction BoxMWOmni/WhipPanelRETRRUSurgeTMAWisp ---FacadeGroundOtherRoof ---BaseChimneyFlushInvertedRoofStealthTopUpright ---Bias TCombinerDi/TriplexerIce ShieldJunction BoxMWOmni/WhipPanelRETRRUSurgeTMAWisp ---FacadeGroundOtherRoof ---BaseChimneyFlushInvertedRoofStealthTopUpright ---Bias TCombinerDi/TriplexerIce ShieldJunction BoxMWOmni/WhipPanelRETRRUSurgeTMAWisp ---FacadeGroundOtherRoof ---BaseChimneyFlushInvertedRoofStealthTopUpright ---Bias TCombinerDi/TriplexerIce ShieldJunction BoxMWOmni/WhipPanelRETRRUSurgeTMAWisp ---FacadeGroundOtherRoof ---BaseChimneyFlushInvertedRoofStealthTopUpright ---Bias TCombinerDi/TriplexerIce ShieldJunction BoxMWOmni/WhipPanelRETRRUSurgeTMAWisp ---FacadeGroundOtherRoof ---BaseChimneyFlushInvertedRoofStealthTopUpright ---Bias TCombinerDi/TriplexerIce ShieldJunction BoxMWOmni/WhipPanelRETRRUSurgeTMAWisp ---FacadeGroundOtherRoof ---BaseChimneyFlushInvertedRoofStealthTopUpright ---Bias TCombinerDi/TriplexerIce ShieldJunction BoxMWOmni/WhipPanelRETRRUSurgeTMAWisp ---FacadeGroundOtherRoof ---BaseChimneyFlushInvertedRoofStealthTopUpright ---Bias TCombinerDi/TriplexerIce ShieldJunction BoxMWOmni/WhipPanelRETRRUSurgeTMAWisp ---FacadeGroundOtherRoof ---BaseChimneyFlushInvertedRoofStealthTopUpright ---Bias TCombinerDi/TriplexerIce ShieldJunction BoxMWOmni/WhipPanelRETRRUSurgeTMAWisp ---FacadeGroundOtherRoof ---BaseChimneyFlushInvertedRoofStealthTopUpright ---Bias TCombinerDi/TriplexerIce ShieldJunction BoxMWOmni/WhipPanelRETRRUSurgeTMAWisp ---FacadeGroundOtherRoof ---BaseChimneyFlushInvertedRoofStealthTopUpright ---Bias TCombinerDi/TriplexerIce ShieldJunction BoxMWOmni/WhipPanelRETRRUSurgeTMAWisp ---FacadeGroundOtherRoof ---BaseChimneyFlushInvertedRoofStealthTopUpright ---Bias TCombinerDi/TriplexerIce ShieldJunction BoxMWOmni/WhipPanelRETRRUSurgeTMAWisp ---FacadeGroundOtherRoof ---BaseChimneyFlushInvertedRoofStealthTopUpright ---Bias TCombinerDi/TriplexerIce ShieldJunction BoxMWOmni/WhipPanelRETRRUSurgeTMAWisp ---FacadeGroundOtherRoof ---BaseChimneyFlushInvertedRoofStealthTopUpright ---Bias TCombinerDi/TriplexerIce ShieldJunction BoxMWOmni/WhipPanelRETRRUSurgeTMAWisp ---FacadeGroundOtherRoof ---BaseChimneyFlushInvertedRoofStealthTopUpright ---Bias TCombinerDi/TriplexerIce ShieldJunction BoxMWOmni/WhipPanelRETRRUSurgeTMAWisp ---FacadeGroundOtherRoof ---BaseChimneyFlushInvertedRoofStealthTopUpright ---Bias TCombinerDi/TriplexerIce ShieldJunction BoxMWOmni/WhipPanelRETRRUSurgeTMAWisp ---FacadeGroundOtherRoof ---BaseChimneyFlushInvertedRoofStealthTopUpright CABLE/FIBER/COAX LEASED RIGHTS Type Qty Size Length Fiber ---CAT 5CoaxDC/PowerFiberHybridOtherRET ---CAT 5CoaxDC/PowerFiberHybridOtherRET ---CAT 5CoaxDC/PowerFiberHybridOtherRET ---CAT 5CoaxDC/PowerFiberHybridOtherRET ---CAT 5CoaxDC/PowerFiberHybridOtherRET ---CAT 5CoaxDC/PowerFiberHybridOtherRET ---CAT 5CoaxDC/PowerFiberHybridOtherRET GENERAL SCOPE OF WORK, SPECIAL CONSIDERATIONS AND COMMENTS GENERAL SCOPE OF WORK SPECIAL CONSIDERATIONS AND COMMENTSRow1
