AEZA-PW-HF(210-50p) Date: _______________
MEMORANDUM THRU: 18TH Soldiers Support Group
FOR DPWE ATTN: AFZA-PW-HF
SUBJECT: Request to install a satellite dish/CB antenna
1. I, ____________________________________, request permission to install a 30” satellite
dish/CB antenna, at my assigned housing unit _____________________________________.
Address and community
(Provide a sketch of location of the satellite dish/CB antenna on the back of this form)
2. I understand and agree that I will be responsible for the professional installation of the
satellite dish. Satellite dish/CB antenna will only be installed in the backyard and will not be
attached to any part of the house or trees. The Housing Office will reserve the right to ask for the
removal of said Satellite dish/CB antenna if not adequately maintained or if the CB interferes
with neighbors TV, telephone, etc.
3. Upon termination of my quarters, I will repair/restore the premises to its original condition at
my expense.
_______________________________
Signature of Sponsor
SPONSORING UNIT:
CONCUR: __________________
NON-CONCUR: _____________
COMMENTS: _________________________________________________________________
SIGNATURE SPONSORING REP: ______________________________________
DATE: ____________________
HOUSING DIVISION:
APPROVAL: _______________
DISAPPROVAL: ____________
COMMENTS: ______________
HSG REP: ____________________________________________
DATE: ____________________