Cellular Antenna Attachment Process
Memphis Light, Gas & Water Site Application Form
Telecommunications Engineering Department
220 S. main Street Memphis, TN 38103
Phone: (901) 528-4620
Fax: (901) 528-7783
 
Contact Information
Today's Date:
Sunday May 28, 2017
*Carrier Name:
*Contact Person:
*Phone Number:
Fax Number:
*Address:
*City, State, Zip:
*Email Address:
RF Contact Person:
Type of Connection
*Choose the Connection Type:
Roof Top
Water Tank
TeleCommunications Tower
Transmission Tower
Utility Pole
Land Lease

Site Information
Site ID Number:
*Site Name:
*Address:
*City, State, Zip:
Structure Height:
ft
Ground Elevation:
ft
Latitude:
° .   ' .     . "
Longitude:
° .   ' .     . "
Source of Coordinates:
NAD 83
NAD 87
Other

Equipment Information
Attenna Quantity:
Attenna Size Approx.:
ft
Attenna Height:
ft
Attenna Weight:
lb
Attenna Wind Load:
kips
Ground Space Requirements:
Type/Model:
     Style:
Centerline (AGL):
ft
Beam-Width:
° 
Tx Freq (Mhz):
     Rx Freq (Mhz):
ERP:
dbm
Transmitter Operating Power:
dbm
Site Disclaimer Acknowledgement
    *I acknowledge that I have read and understand the Site Disclaimer Notice (click here to read)