f-ldu-100landuseproposalsubmissionform-navcanada（6页）.doc

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 Struct