Planning and Development
414 King Street, Spruce Grove, AB
Phone: 780-962-7582
Fax:
780-962-1062
RADIOCOMMUNICATION AND BROADCASTING
ANTENNA SYSTEMS APPLICATION
Page 1 of 2
Business Hours
M-F: 8:30 a.m. – 4:30 p.m.
PROJECT LOCATION
Street Address:
Street Name:
Legal Description: Unit / Lot / Block / Plan
or
Quarter / Section / Township / Range / Meridian
/
PROJECT DETAILS
/
/
/
(ADDITIONAL INFORMAT ION CAN BE SUBMITTED ON A SEPARATE PIECE OF PAPER)
1)
Is the proposal a co-location on an existing tower, or will it be an antenna on an existing structure?
If the answer is ‘no’, respond to question #2
Yes
No
2)
If a new tower or structure is proposed:
a. are guy wires proposed?
Yes
No
b.
what is the height of the structure?
_____________ metres
c.
is lighting or painting required by Transport Canada?
Yes
d.
will co-location opportunities be available for other carriers on this structure?
PROJECT DESCRIPTION
No
Yes
No
(PROVIDE ADDITIONAL INFORMATION REGARDIN G THE LOCATION & DES IGN OF STRUCTURE)
OWNER OR REPRESENTATIVE
I am the registered owner of the land described above
I have been designated as the representative of the owner
(written consent attached)
Owner Name:
Agent Name:
Signature:
Signature:
MAILING ADDRESS
Mailing address:
City:
Phone no.:
Fax no.:
Province:
Postal Code:
Owner e-mail address:
Mailing Address
315 Jespersen Ave
Spruce Grove, AB T7X 3E8
This information is being collected under the authority of section 33(c) the Freedom of Information and Protection of
Privacy (FOIP) Act. It will be used to administer a radio communication and broadcasting antenna systems permit. The
personal information provided will be protected in accordance with Part 2 of the Act. If you have any questions
regarding the collection, use and disclosure of personal information, please contact the FOIP Coordinator at 780-9622611.
Planning and Development
414 King Street, Spruce Grove, AB
Phone: 780-962-7582
Fax:
780-962-1062
APPLICANT
RADIOCOMMUNICATION AND BROADCASTING
ANTENNA SYSTEMS APPLICATION
Page 2 of 2
Business Hours
M-F: 8:30 a.m. – 4:30 p.m.
 SAME AS OWNER/REPRESENTATIVE
Applicant Name:
Phone no.:
Fax no.:
Company Name:
Mailing address:
City:
Applicant’s signature
Province:
Postal Code:
Date
APPLICATION CHECKLIST
In addition to the information required on the application form above, the following information is required in support of a Radiocommunication and
Broadcasting Antenna application:
1.
Application fee, if applicable.
2.
Co-location analysis, if required by Planner at time of pre-application meeting. If co-location is not possible, the analysis should provide
reasons for not co-locating, including maps showing target service area and location of other wireless facilities that serve said area.
Evidence backing the reasons for not co-locating shall be provided in support of application.
3.
Environmental Assessment, or other environmental studies, if required by Planner at time of pre-application meeting.
4.
If public
a.
b.
c.
d.
e.
5.
Site map, drawn to scale, that includes:
a.
Distance to all existing buildings within radius equal to height of proposed structure;
b.
Proposed service cabinets, transformers and other above-ground accessory servicing equipment or buildings;
c.
Site access and circulation;
d.
Proposed fencing locations;
e.
Proposed guy wire tie-down locations, if applicable;
f.
Proposed landscaping; and
g.
Other improvements existing on the subject property.
6.
Elevation drawings of the proposed structures, drawn to scale.
7.
Photo simulation, as determined by Planner at time of pre-application meeting.
8.
Other information requested at pre-application meeting (specify in space below).
consultation is required, as determined by Planner at time of pre-application meeting, the following shall be submitted:
A copy of all comments received;
A copy of the sign-in sheet;
A copy of the notification letter mailed to residents;
A copy of the newspaper advertisement; and
A copy of the official meeting transcripts, as provided by a licensed Court Reporter.
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Mailing Address
315 Jespersen Ave
Spruce Grove, AB T7X 3E8
This information is being collected under the authority of section 33(c) the Freedom of Information and Protection of
Privacy (FOIP) Act. It will be used to administer a radio communication and broadcasting antenna systems permit. The
personal information provided will be protected in accordance with Part 2 of the Act. If you have any questions
regarding the collection, use and disclosure of personal information, please contact the FOIP Coordinator at 780-9622611.