PERMIT FOR NPA AND LANDING ON RWY 11 LKV-PR-XX-17 LKKV

PERMIT FOR NPA AND LANDING ON RWY 11 LKKV

PERMIT NUMBER LKV-PR-XX-17 PERMIT ISSUED XX. YY. 2017

This Permit for Non precision approach (NPA) and landing on LKKV RWY11 is being temporarily issued by Karlovy Vary Airport responsible manager based on the following restrictions from Czech Civil Aviation Authority (CAA): 1. Operation of aircraft with wingspan over 24m on RWY11 is possible only after prior written permission from aerodrome operator. 2. Aerodrome operating minima RVR 1 500m for landing on RWY11 is temporarily increased to VIS 3 000m. CAA restrictions are issued due to the following reasons: a) Non standard position of PAPI and aiming point marking on RWY 11 – distance from displaced threshold RWY11 is 161m, b) Minimum wheel clearance over displaced THR RWY11 is not ensured (MEHT 5.9m/19.19ft) – pilot shall pay special attention during approach and landing. c) Single Approach Lightning System (SALS) for RWY11 is not installed. PAPI and aiming point marking will be moved to a standard position as soon as possible or till 30th April 2017 at the latest, SALS will be instaled till 30th June 2017 at the latest. While the time being Aircraft Operator intending to operate the aicraft with wingspan over 24m using NPA approach and landing on RWY11 must filled in and send to the Aerodrome Operator in written below mentioned Request prior beginning of operation on LKKV RWY11. LKKV will review the request and will send back Permit as soon as possible provided aircraft operator safety actions are considered sufficient. Please accept our apologies for any inconvenience this restriction and subsequent request may temporarily cause to your operation. REQUEST FOR NPA AND LANDING ON LKKV RWY11

OPERATOR NAME STATE CITY STREET/NUMBER

CITY POSTAL CODE FAX NUMBER

PHONE NUMBER E-MAIL

AIRCRAFT TO BE OPERATED WITH WINGSPAN > 24m AIRCRAFT TYPE 1 VERSION AIRCRAFT TYPE 2 VERSION

AIRCRAFT TYPE 3 VERSION

AIRCRAFT OPERATOR SAFETY ACTION SAFETY ASSESMENT PERFORMED? YES NO HAZARDS IDENTIFICATION PERFORMED? YES NO HAZARDS CONCEQUENCES, SEVERITY AND PROBABILITY SPECIFIED? YES NO RISK LEVEL DETERMINED AND ACCEPTED? YES NO CURRENT SAFETY BARIERS SUFFICIENT? YES NO ADDITIONAL MITIGATING/PREVENTIVE ACTIONS TAKEN? YES NO FLIGHT CREW INFORMED? YES NO

AIRCRAFT OPERATOR RESPONSIBLE MANAGER Hereby I declare that we accept the infrastructure conditions on LKKV [specified in points 1),2) and a), b), c) above] and we have taken appropriate safety actions to ensure acceptable level of safety during non precision approaches and landings on RWY11 at LKKV.

NAME/SURNAME POSITION

DATE SIGNATURE

Blue tables to be filled by Aircraft Operator responsible manager (Flight Safety Manager, Chief Pilot or Aircraft Commander).

AERODROME OPERATOR RESPONSIBLE MANAGER

PERMIT FOR NPA AND LANDING ON RWY 11 LKKV GRANTED? YES NO

NAME/SURNAME VÁCLAV ĆERNÝ POSITION CHIEF EXECUTIVE OFFICER

DATE SIGNATURE

Red tables to be filled by Karlovy Vary Airport responsible manager.

VERZE: PRVNÍ VYDÁNÍ 17. 1. 2017 STRÁNKA 1/1