County of Moore
Planning and Transportation
Inspections/Permitting: (910) 947-2221
Planning: (910) 947-5010
Transportation: (910) 947-3389
Fax: (910) 947-1303
Applicant Information
Applicant Name: ______________________________ Contact Name: _______________________________________
Address: _______________________________ City: ________________________ State: ______ Zip: ________
Office Phone: ______________________ Cell Phone: _________________________ Fax: ____________________
Email: _________________________________
Applicant Classification: □ Commercial Wireless Provider □ Governmental User □ Private Business User
Is this a joint application by two or more wireless service providers? □ YES □ NO
If this is a joint application, please attach contact information for each additional applicant.
Parcel Information
ParID #: _________________________ Zoning District: ____________________________________________
Address:_______________________________ City: ________________________ State: ______ Zip: ________
Landowner Information
Landowner Name: _____________________________________ Phone: _____________________________________
Address:_______________________________ City: ________________________ State: ______ Zip: ________
WCF Owner Information
Owner Name: _________________________________ Contact Name: ______________________________________
Address:_______________________________ City: ________________________ State: ______ Zip: ________
Office Phone:______________________ Cell Phone: ________________________ Fax: ________________________
Email: _________________________________
WCF Facility Information
Street Address:_______________________________ City: ___________________ State: ______ Zip: ________
Latitude: _______________________________ Longitude: _______________________________________________
Support structure height: _________________ Ground elevation (ASML): __________________________________
Support structure description: □ Monopole □ Rooftop □ Self Supporting Lattice Tower □ Guyed Tower □ Other
Height of proposed co-location (AGL): ___________________ Additional co-locations available? □ YES □ NO
Current Co-Locations (Please identify owners, and heights, of all other co-locations that are on the support structure.)
Co-location 1: Name:__________________________________ Height: ___________________________________
Co-location 2: Name:__________________________________ Height: ___________________________________
Co-location 3: Name:__________________________________ Height: ___________________________________
Co-location 4: Name:__________________________________ Height: ___________________________________
Co-location 5: Name:__________________________________ Height: ___________________________________
Co-location 6: Name:__________________________________ Height: ___________________________________
Describe the extent of the modification(s) including but not limited to any replacements, upgrades, height changes,
size changes, ground work, generators, electrical work, signage, etc.:
Please check each item per the Moore County Unified Development Ordinance Section 8.99(B):
Site Plan. Drawing in accordance with Section 4.2.C
Radio Frequency. A statement from a registered engineer that the WCF will be maintained and operated in accordance
with all applicable Federal Communications Commission (FCC) rules regarding radio frequency emissions and
interference and if there is interference with public safety communications, the applicant shall utilize procedures set
forth by the FCC and the party causing the interference shall reimburse the County for all costs associated with
resolving the interference.
Structural Analysis. Signed and sealed by a NC Registered Professional Engineer that the support structure upon
completion of the applicant’s installation has the structural integrity to accommodate the proposed equipment and
complies with all applicable Federal and State building, fire, structural, electrical, and safety codes.
Lighting. Applicant shall provide documentation that lighting shall not exceed the Federal Aviation Administration
(FAA) minimum standards (minimum intensity and longest duration between flashes) and shall utilize allowed
downward shielding to minimize visual impact to pedestrians and reduce the potential attraction to migratory birds.
Strobe lights during daylight hours and red lights during nighttime hours unless specifically prohibited by the FAA. A
WCF may utilize a security light controlled by a motion-detector sensor at or near the entrance to the facility.
Owner Authorization. Proof that a property and/or antenna support structure owner’s agent has appropriate
authorization to act upon the owner’s behalf if applicable.
Insurance. Proof of certificates of insurance of general liability insurance in the amount of at least $1,000,000
covering any liability arising out of its construction or operation of the WCF.
Bond. Applicant shall submit a performance bond or letter of credit from an accepted bank in the amount of $20,000
or a bond equal to the written estimate from a qualified tower removal contractor to guarantee that the facility will be
removed when no longer in use. Collocation applicants shall provide evidence that the collocation is covered under
the WCF bond, or shall provide a new performance bond equal to the written estimate from a qualified tower removal
contractor to remove their equipment, cabinets, antenna, feed wires and all other appurtenances in collocation
applicant’s ownership/lease upon applicant’s cessation of use.
US Fish and Wildlife Service submitted information, if applicable. □ Yes □ No
National Environmental Policy Act (NEPA) checklist, if applicable. □ Yes □ No
State Historic Preservation Office (SHPO) letter, if applicable. □ Yes □ No
Federal Aviation Administration (FAA) approval, if applicable. □ Yes □ No
The applicant certifies that all statements, certifications, and representations supplied in this application are true and
correct and that the person signing this application is duly authorized to execute this application and otherwise to act on
the applicant’s behalf with respect thereto:
Printed name: ___________________________________ Dated this _____ day of ____________________, 20__
Signature ______________________________________ Title: ________________________________________
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