Inspections/Permitting: (910) 947-2221
Planning: (910) 947-5010
Transportation: (910) 947-3389
Fax: (910) 947-1303
County of Moore
Planning and Transportation
Application Date:
Applicant: Phone:
Lessor Name: Phone:
Lessor Address: Zip: St: City:
Location/Address of Property:
Wireless Communications Facilities Biennial Operating Permit
Applicant Address: Zip: St: City:
Current Zoning District: Proposed Zoning District:
Facility Address:
Applicant Classication:
Commercial Wireless Provider Governmental User Private Business User
Ground Elevation (AMSL): Support Structure Height (AGL):
Co-Locations Positions on Tower: Are Co-Location Positions Available on Tower:
Co-Location Information: (add additional sheets if more co-locations are present on the tower)
Co-Location 1 Provider: Co-Location 1 Height:
Co-Location 2 Provider: Co-Location 2 Height:
Co-Location 3 Provider: Co-Location 3 Height:
Co-Location 4 Provider: Co-Location 4 Height:
Co-Location 5 Provider: Co-Location 5 Height:
Co-Location 6 Provider: Co-Location 6 Height:
Co-Location 7 Provider: Co-Location 7 Height:
Support Structure Description: _________________________________________________________________________________
Inspections/Permitting: (910) 947-2221
Planning: (910) 947-5010
Transportation: (910) 947-3389
Fax: (910) 947-1303
County of Moore
Planning and Transportation
Oce Use Only:
LRK: __________________________ Received By: ______________________________ Date: _____________________
The applicant represents and certies that the following are true and accurate:
The applicant currently holds a FCC license to provide commercial wireless services and that such license is in good standing or,
if the applicant is not a FCC licensee, that the license of each of its FCC tenants is (are) in good standing.
The wireless telecommunication facility continues to be operated by the applicant and that the applicant has a continuing need
for the facility to meet the requirements of its FCC license.
The wireless telecommunication facility complies with all FCC rules and regulations currently in eect relating to environmental
eects of electromagnetic radiation.
The wireless telecommunication facility as currently constructed, maintained or operated is in compliance with all FAA rules and
The applicant currently has liability insurance in force covering the wireless telecommunication facility in an amount deemed
necessary by the Moore County Wireless Telecommunication Facility Ordinance, and amendments thereto.
The applicant has not constructed, or modied any wireless telecommunication facility on or after the eective date of the Moore
County Wireless Telecommunication Facility Ordinance without the approval of Moore County or, if it has done so, that it has
ceased operating and has removed all aboveground portions of such facilities (not including any part of the foundation).
This application shall not be deemed complete unless accompanied by the following:
Application fee of $300.
The Ordinance Administrator or his/her agent(s) shall advise the applicant of such additional information deemed necessary or
appropriate to process or evaluate this application.
The applicant certies that all statements, certications 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 Title
________________________________________________________ _____________________________
Signature Date
Return Completed Application to:
Moore County Planning and Community Development
PO Box 905
Carthage, NC 28327