gaca_gov_sa · form · processed · 3 chunks
GACA الطبيه العامه للطيران المدني General Authority of Civil Aviation [Non-Text] APPLICATION FOR ESTABLISHMENT OF WATER AERODROME (GACAR PART 137) <table><tr><td>ITEMS NO.</td><td colspan="2">DATA DESCRIPTOPN</td><td colspan="2">INFORMATION(information to be filled with by the Applicant/Operator)</td></tr><tr><td>1.0</td><td colspan="4">DETAILS OF APPLICANT/WATER AERODROME OPERATOR</td></tr><tr><td>1.1</td><td colspan="2">Full name of Applicant/Owner/Water Aerodrome Operator</td><td colspan="2"></td></tr><tr><td>1.2</td><td colspan="2">Address of Applicant/Owner/Water Aerodrome Operator</td><td colspan="2"></td></tr><tr><td>1.3</td><td colspan="2">Nationality of Applicant/Owner/Water Aerodrome Operator</td><td colspan="2"></td></tr><tr><td rowspan="2">1.4</td><td rowspan="2" colspan="2">Telephone and Email of Applicant/Owner/Water Aerodrome Operator</td><td>Tel/Mobile</td><td></td></tr><tr><td>Email</td><td></td></tr><tr><td rowspan="3">1.5</td><td rowspan="3" colspan="2">Full name of Applicant/Owner/Water Aerodrome Operator</td><td>Name</td><td></td></tr><tr><td>Tel/Mobile</td><td></td></tr><tr><td>Email</td><td></td></tr><tr><td>2.0</td><td colspan="2">AGREEMENTS/PERMISSIONS/NO OBJECTIONS</td><td colspan="2">Mention here the Reference of Attached Documents</td></tr><tr><td>2.1</td><td colspan="2">Copy of Water Aerodrome Area Ownership or Use Rights or Lease Agreement</td><td colspan="2"></td></tr><tr><td>2.2</td><td colspan="2">Copy of Permission for establishing Water Aerodrome from Principality/Port Authority</td><td colspan="2"></td></tr><tr><td>2.3</td><td colspan="2">Copy of No-Objection Certificate or Agreement Letter from SANS</td><td colspan="2"></td></tr><tr><td>3.0</td><td colspan="2">GENERAL DETAILS OF WATER AERODROME</td><td colspan="2">INFORMATION(information to be filled with by the Applicant/Owner/Operator)</td></tr><tr><td>3.1</td><td colspan="2">Water Aerodrome name to be used after establishment</td><td colspan="2"></td></tr><tr><td>3.2</td><td colspan="2">Location of Water Aerodrome (Area/City/Province)</td><td colspan="2"></td></tr><tr><td>3.3</td><td colspan="2">Name of the nearest civil airport</td><td colspan="2"></td></tr><tr><td>3.4</td><td colspan="2">Classification of Water Aerodrome (Mark X in one box)</td><td>□ Civil/Public</td><td>□ General Aviation</td></tr><tr><td>3.5</td><td colspan="2">Type of proposed operations (Mark X in one box)</td><td>□ Non-Instrument</td><td>□ Instrument</td></tr><tr><td rowspan="2">3.6</td><td rowspan="2" colspan="2">Water Aerodrome Reference Point (WGS 84 Format)</td><td colspan="2"></td></tr><tr><td colspan="2"></td></tr><tr><td>3.7</td><td colspan="2">Water Aerodrome Elevation (As Applicable)</td><td colspan="2"></td></tr><tr><td>3.8</td><td colspan="2">Probable Date of Completion of the Water Aerodrome</td><td colspan="2"></td></tr></table> GACA-AVSES-AGA-F041 Rev: 2, Date: 11 Sep 25 Page 1 of 2 GACA الحييه العامه لطلب المدن General Authority of Civil Aviation [Non-Text] APPLICATION FOR ESTABLISHMENT OF WATER AERODROME (GACAR PART 137) <table><tr><td>4.0</td><td>TECHNICAL SUBMISSIONS(Attach Report Copy)</td><td>Mention here the Reference of Attached Documents</td></tr><tr><td>4.1</td><td>Water Aerodrome Technical Feasibility Study Report (Must include site selection, weather data of at least last 5 years, tabulated wind data, wind rose analysis, water currents and tidal analysis, approach and take-off climb surfaces, transitional surfaces, orientation, usability factor, air and water turbulences, obstacle limitation surfaces survey, topographical area map, critical/design seaplane details and master plan with drawings showing detail of dimensions of runways, taxi lane, mooring, anchoring, platforms etc.) (Ref. GACAR 137 & ICAO Doc 9184-Table 5.1 Fig 5.1)</td><td></td></tr><tr><td>4.2</td><td>Obstacle Limitation Surfaces Survey Report</td><td></td></tr><tr><td>4.3</td><td>Aeronautical Study Report, if applicable such as in case of obstacle</td><td></td></tr><tr><td>4.4</td><td>Environmental Impact Assessment Report</td><td></td></tr><tr><td>4.5</td><td>Statement of GACA Regulation Compliance (F137-202)</td><td></td></tr><tr><td>5.0</td><td>DETAILS OF CONSULTANT(If Consultant is appointed for Water Aerodrome)</td><td>INFORMATION(information to be filled with by the Applicant/Owner/Operator)</td></tr><tr><td>5.1</td><td>Name and Address</td><td></td></tr><tr><td rowspan="2">5.2</td><td rowspan="2">Contact Details</td><td>Tel/Mobile</td></tr><tr><td>Email</td></tr><tr><td>5.3</td><td>Weather Consultant Entity is Accepted by President of GACA (Attach Copy of GACA letter if consultant is already accepted )</td><td></td></tr><tr><td>6.0</td><td colspan="2">DECLARATION BY THE APPLICANT/OWNER/OPERATOR</td></tr><tr><td colspan="3">We hereby certify that</td></tr><tr><td>6.1</td><td colspan="2">The forgoing information is correct and complete in every respect and no relevant information has been withheld;</td></tr><tr><td>6.2</td><td colspan="2">We have read the GACA Regulation Part 137 and the water aerodrome will be designed in complies with all applicable regulations and will be established as per relevant requirements and provisions in the GACAR Part 137; and</td></tr><tr><td>6.3</td><td colspan="2">We understand that the permission is for establishment of the water aerodrome and we require to apply for authorization or certification of water aerodrome before start of any operations as per the requirements of GACAR 137.</td></tr><tr><td colspan="3"></td></tr><tr><td colspan="2">Signature of Applicant/Owner/Operator</td><td>Name</td></tr><tr><td colspan="2"></td><td></td></tr><tr><td colspan="2">Position held</td><td>Date</td></tr><tr><td colspan="2"></td><td></td></tr></table> GACA-AVSES-AGA-F041 Rev: 2, Date: 11 Sep 25 Page 2 of 2