============================================================ PAGE 1 of 2 | OK | method=ocr-300 | words=225 | chars=1597 | hash=7f718928543201fc ============================================================ 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. Liberty Mobile USVI, Inc. P.O. Box 192296, San Juan, P.R. 00919-2296 jorge.rotger@libertypr.com 787-717-9904 2. Name, title, mailing address and telephone number of owner of property and of developer. Owner Developer Government of the Virgin Islands ___—_Liberty Mobile USVI, Inc 3274 Estate Richmond P.O. Box 192296, San Juan, P.R. 00919-2296 St. Croix, USVI jorge.rotger@libertypr.com 787-717-9904 3. Location of activity. Plot No. 6-4-1 Estate _Carolina Island _ St John 4. Zoning District R-2 Dy Name, mailing address and telephone number of project designer. AW Soluti Calle 22 AA-1 River V R PR 00961 939-338-6610 6. Name, mailing address and telephone number of principal earthwork contractor. Not available at this time T Summary of proposed activity. Include all incidental improvements such as utilities, roads, etc. (Use additional sheets if necessary). Erect 100' self supporting momopole communications tower, construct chain link fence, 12'x30' & 10'x15' concrete equipment pads, electrical service, & 12' wide site access road. 7a. State type of Land Uses as specified in the VI Zoning Law, which are applied for e.g., restaurant, hotel, single dwelling, etc. Wireless facililty ============================================================ PAGE 2 of 2 | PENDING | method=— | words=0 | chars=0 | hash=— ============================================================ (page not yet processed)