GOVERNMENT OF THE VIRGIN ISLANDS OF THE UNITED STATES DEPARTMENT OF PLANNING AND NATURAL RESOURCES DEVELOPMENT PERMIT APPLICATION FORM L&WD-2 PERMIT APPLICATION Date Received:____________ Date Declared Complete:___________ Permit No.__________ Application is hereby made for a Earth Change/Coastal Zone Permit 1. Name, mailing address and telephone number of applicant. 2. Name, title, mailing address and telephone number of owner of property and of developer. Owner Developer _________________________________ ______________________________ _________________________________ ______________________________ _________________________________ ______________________________ 3. Location of activity. Plot No. ______________________________________________ Estate _________________________________ Island ___________________________ 4. Zoning District ___________________________________________________________ 5. Name, mailing address and telephone number of project designer. ________________________________________________________________________ ________________________________________________________________________ 6. Name, mailing address and telephone number of principal earthwork contractor. ________________________________________________________________________ ________________________________________________________________________ 7. Summary of proposed activity. Include all incidental improvements such as utilities, roads, etc. (Use additional sheets if necessary). ________________________________________________________________________ ________________________________________________________________________ 7a. State type of Land Uses as specified in the VI Zoning Law, which are applied for e.g., restaurant, hotel, single dwelling, etc. _______________________________________________________________________ _______________________________________________________________________ Infra Towers, LLC 1800 Diagonal Road, Ste 600 Alexandria, VA 22314 tierney.rowe@infraholdingsllc.com 801-597-4516 Hilltop Properties, LLC 1215 King Cross, Christiansted, St. Croix, VI 00820 mpede@valance.us, 340-277-1364 73 Clairmont St. Croix R-1 Delta Oaks Group, Michael Lloyd Lassiter, 4904 Professional Court Raleigh, NC 27609 Rhett Butler, rbutler@deltaoaksgroup.com, 919-744-0614 TFI, LLC, P.O. Box 1625, Livingston , MI 59047 geoff@towerfoundations.com, 406-842-7260 Construction of a 100' monopalm tower, capable of supporting up to three wireless carriers. The tower will be placed within 30'x50' fenced enclosure. The area around the tower will be graveled and will contain a generator and support equipment. Wireless Support Structure and Wireless Facility