Rank/Title		Name
Unit/Organisation
E-mail
Telephone
FAX

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New structure

Removal of structure

Changes made to structure

LOCATION AND DESCRIPTION OF STRUCTURE

Type of structure	Unknown Building Cable span Chimney Lighthouse or hazard beacon Mast Small obstructions Spire Tank Terrain or Spot Heights Tower Tree Wind generator Other Other
Identification of the Structure (if known) e.g. Company reference No.
State or territory	(select state) Australian Capital Territory New South Wales Northern Territory Queensland South Australia Tasmania West Australia Victoria International
Nearest Town/Landmark
Locality or featurename
Description of structure
Owner of structure
Is structure temporary?	YES NO Not sure.
	If YES, expected date of removal

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SURVEY DATA

Datam type	Unknown WGS84/GDA94 AGD 66 Other	Other
Position Latitude (eg S 34 44' 14.5")		or	UTM Grid reference		Zone (zone) 49 50 51 52 53 54 55 56 other other
Position Longitude (eg E 149 26' 54")
Positional accuracy (if available)		Meters Feet
Date of last survey (if known)		Year of erection
Height of obstruction		Meters Feet
Height accuarcy (±)		Meters Feet
Ground level elevation at base of structure (if known)		Meters Feet
Height of structure from ground level including antenna/aerial(s)		Meters Feet
Elevation* to top of structure including antenna/aerial(s)		Meters Feet

* Elevation values are referenced in Mean Sea Level (AMSL) or the Australian Height Datum (AHD) and values are requested in feet or to the 1/10th metre.

How was the data captured:

1st order survey	Stereo photogrammetric		Mono photogrammetric
Chart/map derived	Handheld GPS (non survey)		Reported
Other

Guy-wire footprint Meters Feet (Lateral distance from structure eg. 35 metres)

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MARKING
Obstacle marking YES NO Not sure
Obstacle Lighting YES NO Not sure

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OTHER REMARKS