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□ □ □ PICKENS COUNTY PLANNING & DEVELOPMNENT 1266 East Church Street, Suite 136 Jasper, GA 30143 Phone [PHONE REDACTED] Email: [EMAIL REDACTED] Fax [PHONE REDACTED] TOWER PERMIT APPLICATION Date Please Check Application Type(s): New Tower Modification Co-locate Applicant of Permit: Applicant Site Number: Mailing Address: City State Zip Tower Owner: Mailing Address: City State Zip Property Owner: Parcel Number: Physical Location: City State Zip Description of project and/or modification: Additional Comments: ANY ALTERATIONS, DEVIATIONS, RELOCATIONS, OR CHANGES TO THIS APPLICATION WILL VOID THIS PERMIT FOR PLANNING & DEVELOPMENT USE ONLY Date Paid: Approved By: Receipt: Fees Paid: New Tower Modification Co-locate Application Fee: Yes No