5 Airpark Road
West Lebanon, NH 03784
(603)
29
8-8878
TRANSIENT SERVICE OPERATOR PERMIT APPLICATION
Permittee Name:
Address:
Business #: Other #: Email
D
escription of Services: ____________________________________________________________________
A
ircraft Information:
Tail Number: ________________ Type: ________________ Owner: ________________________________
Loc
ation of Services: ______________________________________________________________________
A separate application is required for each repair occurrence.
Permit Fees:
□ Piston Engine - $250 □ Turbo Prop Engine - $500 □ Turbine Engine - $750
T
he following information must accompany this application:
Copy of applicable Service Operators Certifications
Certificate of Insurance naming the City of Lebanon as an additional insured
Please read the following carefully before signing.
I acknowledge receiving a copy of the Lebanon Municipal Airport Rules and Regulations. I further understand and shall comply
with said rules. I also certify that I have read and understand the application and that all the information presented is true and
accurate. I realize that any misrepresentation in this information or failure to comply with ordinances in the City of Lebanon and
Lebanon Municipal Airport may result in the immediate suspension or revocation of the permit and revoked access to the
Airport.
Applicant Authorized Signature Date
Applicant Printed Name & Title
P
lease send completed application package to: airport.manager@lebanonnh.gov
or deliver to 5 Airpark Road, West
Lebanon, NH 03784.
AIRPORT USE ONLY
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signature
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