LandUseProposal.docVIP

Land Use Proposal Submission Form Date Received by NAV CANADA NC file N°./ Ref N° TC File N° / Ref N° General Information: Company/Owner Name: Contact Person: Address: City: Prov: Postal Code: Tel: Fax: Email: 24 Hour Emergency Number: Applicant: Contact Person: Address: City: Prov: Postal Code: Tel: Fax: Email: 24 Hour Emergency Number: Airport Authority?: (If within 6 km of a lighted aerodrome) Airport Manager: Address: City: Prov: Postal Code: Tel: Fax: Email: Details of Proposal: Please provide the data in the highest resolution as it was obtained. For geographic coordinates, provide up to four (4) decimal places of a second. For ground elevation and tower height, provide up to four (4) decimal places of a metre or foot. Project #, Street Address, etc.: Nearest Town, Province: Degrees Minutes Seconds Degrees Minutes Seconds Geographic Coordinates of Site in NAD 83: Lat. N / / Long. W / / Linear Structures: Indicate Starting Point on 1st line and End Point 2nd line: Lat. N / / Long. W / / Type of Structure: New Structure? Yes No Height Added (If Existing) ft m Cranes to be used? Yes No If Yes, see instructions Ground Elevation (Above Sea Level) ft m Dimensions: Structure Height (Above Ground Level) ft m Materials Roof Shape (If Building): Total Height (Above Sea Level) Structure Height + Ground Elevation ft m Proposed Construction Start Date: Approximate Duration of Construction: If Temporary Structure, indicate Removal Date: From: hrs To: hrs Comments: Electronic / Telecommunication Interference (Check off the items which may cause interference and provide details) Dddddddddddd High Voltage Equipment Details Arc Wel