4G Small Cell OPW

• Site Name

• Date of Walk

  Date

• Site Photo

  Media

• Notes

SITE LOCATION & CANDIDATE

• Site Location
  Address

• Candidate Letter Designation

  A

  B

  C

POLE CHARACTERISTICS

• Pole Type

  Existing Pole

  New Pole

• Pole Material

  Wooden

  Metal

  Other

• Select One

  Utility Pole

  Utility Pole w/ Light

  Light Pole

  Other

• Select One

  Utility Pole

  Utility Pole w/ Light

  Light Pole

  Other

• Decorative

  Yes

  No

• Explain.

• Pole will be located in Active Utility ROW

  Yes

  No

  Other

• Explain

POWER

• Power to Pole

  Overhead

  Underground

  Other

• (If Other) Explain.

• Distance to Nearest Transformer

• Distance to Nearest Power Source

• Power Notes (Additional)

REPLACEMENT INFO

• Replacement Information

HOME OWNER ASSOCIATION (HOA)

• HOA

  Yes

  No

• HOA Details

HISTORIC DISTRICT

• Historic District

  Yes

  No

• Historic District Details

PRIVATE PROPERTY

• Private Property

  Yes

  No

• Private Property Details

ENVIRONMENTAL CONCERNS

• Environmental Concerns

  Yes

  No

• Explain.

AESTHETIC CONCERNS

• Aesthetic Concerns

  Yes

  No

• Explain.

RIGHT OF WAY (ROW)

• Public Right of Way (PROW)

  Yes

  No

  Other

• PROW Details

• Explain

LOCATION

• Jurisdiction Notes

SITE PHOTOS

• Additional Photos

  Media

SITE LOCATION & CANDIDATE

• Site Location
  Address

• Candidate Letter Designation

  A

  B

  C

POLE CHARACTERISTICS

• Pole Type

  Existing Pole

  New Pole

• Pole Material

  Wooden

  Metal

  Other

• Select One

  Utility Pole

  Utility Pole w/ Light

  Light Pole

  Other

• Select One

  Utility Pole

  Utility Pole w/ Light

  Light Pole

  Other

• Decorative

  Yes

  No

• Explain.

• Pole will be located in Active Utility ROW

  Yes

  No

  Other

POWER

• Power to Pole

  Overhead

  Underground

  Other

• (If Other) Explain.

• Distance to Nearest Transformer

• Distance to Nearest Power Source

• Power Notes (Additional)

REPLACEMENT INFO

• Replacement Information

HOME OWNER ASSOCIATION (HOA)

• HOA

  Yes

  No

• HOA Details

HISTORIC DISTRICT

• Historic District

  Yes

  No

• Historic District Details

PRIVATE PROPERTY

• Private Property

  Yes

  No

• Private Property Details

ENVIRONMENTAL CONCERNS

• Environmental Concerns

  Yes

  No

• Explain.

AESTHETIC CONCERNS

• Aesthetic Concerns

  Yes

  No

• Explain.

RIGHT OF WAY (ROW)

• Public Right of Way (PROW)

  Yes

  No

  Other

• PROW Details

• Explain

LOCATION

• Jurisdiction Notes

SITE PHOTOS

• Additional Photos

  Media