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Liberty County Building and Licensing Department Telecommunications Tower/ Antenna Building Permit Application Property Owner: Mailing Address: Telephone Permittee Name: Mailing Address: Telephone Contact Name & Phone Property Address: (if existing) Contractor: Class of Work: Flood Zone: Tower Height (or existing tower height): For Co-Locates: Antenna Height: General: New total tower height: Electrician: Please attach the following information: Two Engineered Sets of Plans Zoning Approval Sheet Capacity & Remaining Integrity FOR OFFICE USE ONLY Director Approval: Date: Inspector Approval: Date: Map & Parcel # Zoning: Contractors Business Licnese Job Scope Detail & Valuation $196.00 Building Permit Fee FCC Certification Electricians State & Business License Our Contact Information: Office [PHONE REDACTED] Location: 112 North Main Street Room 1200 Fax [PHONE REDACTED] Hinesville, Georgia 31313 Mailing: 100 Main Street Suite 7410 Hinesville, Georgia 31313 Antenna (co-locate) New Tower Repairs ---PAGE BREAK--- List of Subtractors to work on this job General Contractor: Contact Electrical Contractor: Contact Concrete Contractor: ---PAGE BREAK--- LCPC Use Only Zoning Permit Tax Map & Parcel # : You can obtain this number by calling the Tax Assessor's Office at [PHONE REDACTED]. Property Owner: Contact Name & Number: Contact Mailing Address: Property Street Address (if existing): Subdivision: lot: Jurisdiction: What are your permit plans? Type of water and sewer: If other explain: What structures are on this property? I confirm that these statements are true: List Zoning Designation Unincorporated Area of Liberty County City of Walthourville City of Flemington___________City of Midway of Riceboro Town of Allenhurst City of Grumbranch City of Hinesville Setbacks: Front Rear: Side: Side Street: Mobile Home Requirement: Size: Skirting Type: Comments: Approved; meets Zoning Standards Disapproved, does not meet Zoning Standards LCPC staff: Date: Floodplain Manager Use Only Flood Zone: Elevation FEMA Map Date: FIRM Map & Panel Jeff Ricketson, AICP Executive Director Liberty Consolidated Planning Commission 100 Main Street, Suite 7520 Hinesville, Georgia 31313 Phone: [PHONE REDACTED] Fax:1-[PHONE REDACTED] Jurisdiction H City of Hinesville LC Unincorporated Liberty County M Midway W Walthourville A Allenhurst G Gumbranch R Riceboro F Flemington