Transcription of TA-W41337: Occupancy Permit Application
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TA-W41337: Occupancy Permit Application
new york state thruway AuthorityOCCUPANCY Permit APPLICATIONTA- w41337 (11/2015) Page 1 of 3 For Official Use OnlyOccupancy Permit Permit Permit :Applicant: Please print or type. Read and complete Sections I through V. Division Permit Coordinator: Forward completed Application to HQ Permit Coordinator. Applicant Identification InformationSection I(Check one) Individual Not for Profit Utility Public Agency Municipality Business/Corporation Amended NewNameFederal ID AddressStreet BoxTown/Village/CityStateContact Person NameZip Code-Phone No. )(-)(Fax AddressFacility Identification InformationSection IILOCATION OF FACILITY (check all that apply)UndergroundDepth in inchesAerialSurfaceLongitudinalTransvers e - Offset from bridge or cross street Bridge AttachmentfeetMILEPOST BOUNDARY (if known)Beginning Milepost longitudinal, include ending Milepost of travel (N/S/E/W)GPS Coordinates (if known)IF APPLICABLE, CHECK ONE Utility agreement Co-locate agreement Master agreement/permitTYPE AND SIZE OF FACILITY (check one and enter size if known) Building Structure Communications Tower Communications Tower/Co-Locate Drainage Storage Parking Fiber O
New York State Thruway Authority. OCCUPANCY PERMIT APPLICATION. TA-W41337 (11/2015) Page 1 of 3. For Official Use Only. Occupancy Permit No. Construction Permit No.
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