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EXHIBIT B <br />Applicant: <br />APPLICATION TO USE MUNICIPAL FACILITY <br />Date: <br />Licensee: Application/License#: <br />Type of <br />Municipal <br />Facility <br />Alteration <br />Required <br />Equipment Heights <br />(provide both (1) the overall <br />height ofpole structure with <br />added facilities; and (2) the <br />height of individual <br />facilities <br />Equipment <br />and Base <br />Equipment <br />weights <br />Equipment and <br />Base <br />Equipment <br />Dimensions <br />Location of Any Existing <br />Equipment <br />[street light] <br />[Pole <br />[Installed on Pole, specify <br />[traffic light] <br />Reinforcement] <br />attachment height, weight <br />[other, <br />[Pole <br />and dimensions] <br />specify] <br />Replacement] <br />[Installed on/in Ground <br />(None] <br />(Vault), specific <br />dimensions] <br />[Other Location] <br />[Not Applicable/Needed] <br />APPLICANT SHALL PROVIDE THE FOLLOWING AS APPLICABLE: <br />• Site plan and engineering design and specifications for Equipment, including the location <br />of radios, antenna facilities, transmitters, equipment shelters, cables, conduit, point of <br />demarcation, backhaul solution, electrical distribution panel, electric meter, and electrical <br />conduit and cabling. 'Where applicable, the design documents should include specifications <br />on design, pole modification, and ADA compliance. Also indicate whether unmetered <br />electricity is available at the site. <br />• If necessary, include a load bearing study that determines whether the pole requires <br />reinforcement or replacement in order to accommodate attachment of proposed Equipment. <br />• If the Equipment will require reinforcement or replacement of an existing pole, provide <br />applicable design and specification drawings. <br />• The number, size, type and proximity to the facilities of all communications conduits) and <br />cables currently installed and/or proposed to be modified. <br />• Description of the utility services required to support the Equipment. <br />• List of the contractors and subcontractors, and their contact information, authorized to work on <br />the project. <br />• A check for the applicable Application Fee made payable to the City of Santa Ana (refer to <br />Section 5.1 of the Municipal Facilities License Agreement). <br />APPLICANT SIGNATURE: <br />PRINT NAME: <br />TITLE: <br />B-1 <br />190735027_1 <br />