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Requirements for Wireless Support Structures & Substantial Applicant
Modifications Initial
❑ Affidavit certifying the construction and placement of wireless facilities
meets the provisions of the Federal Communications Act, 47 U.S.0 332, as
amended, Section 6409 of the Middle Class Tax Relief and job Creation Act of
2012, 47 U.S.C. 1455(a), in accordance with the rules promulgated by the AJB
Federal Communications Commission (FCC), and all other applicable federal,
state, and local laws.
❑ Simulated photographic evidence of the proposed appearance of the
wireless support structure and wireless facilities from at least four (4) vantage
points and a statement as to the potential visual and aesthetic impacts on all AJB
adjacent residential zoning districts.
❑ Determination of No Hazard to Air Navigation, or other applicable
determination by the Federal Aviation Administration (FAA) upon review of ATB
FAA form 7460.
❑ For New Wireless Support Structures: Information or materials providing
evidence that collocating new antennae and equipment on an existing
wireless support structure or structures within the applicant's search ring is AJB
not reasonably feasible if the collocation is technically or commercially
impractical orthe owner of the existing wireless support structure is unwilling
to enter into a contract for such use at fair market value.
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Special Use Permit Application - Updated 03-2026
Acknowledgement and Signatures
Note: This form must be signed by the owner(s) of record. A signature is required for each owner of
record if there are multiple owners.
By signing below, I understand and accept the following:
• All the conditions, limitations, and obligations of the conditional rezoning process for which I am
applying.
• That the existing Official Zoning Map is presumed to be correct.
1 understand that the applicant has the burden of proving the proposal meets the four required
conclusions.
I certify that this application is complete, and all information presented in this application is accurate
to the best of my knowledge, information and belief.
• 1 am legally able to make decisions regarding the subject property and apply for this application to
make changes to the subject property.
If applicable, I also appoint the applicant/ agent listed on this application to represent me and make
decisions on my behalf regarding this application during the review process.
The applicant / agent is hereby authorized on my behalf to:
1. Submit an application including all required supplemental information and materials;
2. Appear at public hearings to give representation and comments;
3. Act on my behalf without limitations with regard to any and all things directly or indirectly
connected with or arising out of this application; and
4. Provide written consent to any and all conditions of approval.
An authorized agent or the property owner will attend each public hearing scheduled for the
application to represent the request and answer questions if called upon.
If changes are made to the proposal afterthe application completeness determination that require
additional staff review and vetting, the changes will be ineligible to move forward to the intended
Planning Board agenda. No changes will be accepted by staff after the applications are posted at
the time of public notice.
If a request is made to delay consideration by the Planning Board or Board of Commissioners before
public notice has been sent out in the mail or to the newspaper, the item will be calendared for the
next meeting and no fee will be required. If delay is requested after notice has been sent to the
newspaper, the Board will act on the request at the scheduled meeting and are under no obligation
to grant the continuance. If the continuance is granted, a fee in accordance with the county's
adopted fee schedule will be required.
Signature of Property Owner / Authorized Agent
Anthony J. Bologna
Print Name
0� i ❑ �Z�
Date
By: Anthony J. Bologna, Agent on behalf of Southeastern Enterprises, Inc. and EIP Holdings IV, LLC
Signature of Property Owner / Authorized Agent Print Name Date
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Special Use Permit Application - Updated 03-2026