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EXHIBIT B <br />APPLICATION TO USE MUNICIPAL FACILITY <br />Applicant: Date: <br />Licensee: Application/License#: <br />Type of <br />Municipal <br />Facility <br />Alteration <br />Required <br />small cell Equipment <br />Heights (provide both (1) <br />the overall height of pole <br />structure with added <br />facilities; and (2) the height <br />of individual facilities) <br />small Cell <br />and Base <br />Equipment <br />Weights <br />small Cell <br />And Base <br />Equipment <br />Dimensions <br />Location of Any <br />Additional Equipment <br />[street light] <br />[Pole <br />[Installed on Pole, spec <br />[traffic light] <br />Reinforcement] <br />attachment height, weight <br />[other, <br />[Pole <br />and dimensions] <br />spec] <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 />Is Site plan and engineering design and specifications for installation of Equipment, including <br />the location of radios, antenna facilities, transmitters, equipment shelters, cables, conduit, <br />point of demarcation, backhand solution, electrical distribution panel, electric meter, and <br />electrical conduit and cabling. Where applicable, the design documents should include <br />specifications on design, pole modification, and ADA compliance. Also indicate whether <br />unmetered electricity is available at the site. <br />• Include a load bearing study that determines whether the pole requires reinforcement or <br />replacement in order to accommodate attachment of proposed Equipment. <br />• If the proposed installation will require reinforcement or replacement of an existing pole, <br />provide applicable design and specification drawings. <br />• The number, size, type and proximity to the facilities of all communications conduit(s) and <br />cables to be installed. <br />• Description of the utility services required to support the facilities to be installed. <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 />