Fillable APPEALS OF ADMINISTRATIVE DECISIONS (Hillsborough County)

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APPEALS OF ADMINISTRATIVE DECISIONS (Hillsborough County)

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APPEALS OF ADMINISTRATIVE DECISIONS
IMPORTANT INSTRUCTIONS TO ALL
APPLICANTS:
You must schedule an appointment to submit this application. To request an appointment please
Call 813
272-5600.
All requirements listed on the submittal checklist must be met.
Incomplete applications will not be
accepted.
Property
Information
Address:
City/State/Zip:
TWN-RN-SEC:
Folio(s):
Zoning:
_Future
Land
Use:
Property
Size:
Property Owner
Information
Name:
Daytime
Phone:
Address:
City/State/Zip:
Email:
FAX
Number:
Applicant
Information
Name:
Daytime
Phone:
Address:
City/State/Zip:
Email:
FAX
Number:
Applicant’s Representative
(if different than above)
Name:
Daytime
Phone:
Address:
City
/
State/Zip:
Email:
FAX
Number:
I HEREBY SWEAR OR AFFIRM THAT ALL THE INFORMATION
PROVIDED IN THIS APPLICATION PACKET IS TRUE AND
ACCURATE, TO THE BEST OF MY KNOWLEDGE, AND
AUTHORIZE THE REPRESENTATIVE LISTED ABOVE TO ACT ON
MY BEHALF FOR THIS APPLICATION.
I HEREBY AUTHORIZE THE PROCESSING OF THIS APPLICATION
AND RECOGNIZE THAT THE FINAL ACTION ON THIS PETITION
SHALL BE BINDING TO THE PROPERTY AS WELL AS TO
CURRENT AND ANY FUTURE OWNERS.
Signature of Applicant
Signature of Property Owner
Type or Print Name
Type or Print Name
Office Use Only
Intake
Staff
Signature:
Intake
Date:
Case
Number:
Public
Hearing
Date:
Receipt Number:
Type of Application:
Development Services, 601 E Kennedy Blvd. 20
th
Floor
Revised 10/01/2014
Application Number: _________________
AFFIDAVIT TO AUTHORIZE AGENT
STATE OF FLORIDA
COUNTY OF HILLSBOROUGH
(NAME OF ALL PROPERTY OWNERS), being first duly sworn, depose(s) and say(s):
1. That (I am/we are) the owner(s) and record title holder(s) of the following described property, to wit:
ADDRESS OR GENERAL LOCATIONS: ______________________________
Folio No: __________________
2. That this property constitutes the property for which a request for a:
(NATURE OF REQUEST) is being
applied to the Board of County Commissioners, Hillsborough County.
3. That the undersigned (has/have) appointed
as
(his/their) agent(s) to execute any permits or other documents necessary to affect such permit.
4. That this affidavit has been executed to induce Hillsborough County, Florida, to consider and act on the above-
described property;
5. That (I/we), the undersigned authority, hereby certify that the foregoing is true and correct.
____________________________________ _______________________________________
Signature (Property Owner) Signature (Property Owner)
STATE OF FLORIDA
COUNTY OF HILLSBOROUGH
The foregoing instrument was acknowledged before
me this ____________by ______________________________
Date
Property Owner
Who:
_____Personally known to me _____Florida Drivers License
______Other Type of Identification
And Who:
______did _______did not take an oath.
___________________________________________________
Signature of Notary taking acknowledgement
___________________________________________________
Type/Print Name of Notary
___________________________________________________
Commission Number Expiration Date
STATE OF FLORIDA
COUNTY OF HILLSBOROUGH
The foregoing instrument was acknowledged before
me this ____________by ______________________________
Date
Property Owner
Who:
______Personally known to me ______Florida Drivers License
______Other Type of Identification
And Who:
______did _______did not take an oath.
___________________________________________________
Signature of Notary taking acknowledgement
___________________________________________________
Type/Print Name of Notary
___________________________________________________
Commission Number Expiration Date
THIRD PARTY
NOTICE OF APPEAL HEARING
DATE: ________________________________________________
(date)
APPEAL NUMBER: ________________________________________________
(number)
APPELANT: ________________________________________________
(name)
NAME OF PROPERTY OWNERS(S): ________________________________________________
(name)
MAILING ADDRESS OF PROPERTY
OWNER(S): ________________________________________________
(address)
ADDRESS/LOCATION OF PROPERTY: ________________________________________________
(address)
FOLIO #: ________________________________________________
(folio number)
YOU ARE HEREBY NOTIFIED that an appeal of an administrative decision has been filed with the Hillsborough
County Development Services Department.
The appeal has been scheduled for a hearing before the Hillsborough County Land Use Hearing Officer for
Monday, ________________________, at 1:30p.m.
Hillsborough County Center
County Commissioner’s Board Room
601 E. Kennedy Blvd., 2
nd
Floor
Tampa, FL 33602
As owner of real property that is the subject of the administrative decision, you are notified of the filing of this
appeal and the setting of the matter before the Land Use Hearing Officer as defined in 10.05.01.C of the Land
Development Code.
Please direct all inquiries regarding this appeal to Rosa Timoteo (813-307-1752):
Development Services Department
601 E. Kennedy Blvd., 20
th
Floor
Tampa, FL 33602
Appellant Name: __________________________________________________________________
Appellant Address: __________________________________________________________________
Decision being appealed __________________________________________________________________
Date of decision appealed __________________________________________________________________
APPEALS OF ADMINISTRATIVE DECISIONS
A. General Description: Appeals to decisions made by the A dministrator;
B. Cross Reference to Development Code: Section 10.05.00
APPEALS FROM ADMINISTRATOR TO LAND USE HEARING
OFFICER
Applications for appeals of administrative decisions are considered and decided by the LUHO in
accordance with Section 10.05.01 of the LDC. This section includes the application submittal
requirements for appeals to the Administrative decisions.
A. Submittal Requirements
The submittal requirements to appeal a decision of the Administrator are as follows:
1. Fee Payment - as referenced in Section 2.0 of the Development Review Procedures Manual.
2. Application - as referenced in Section 3.0 of the Development Review Procedures Manual.
3. Affidavit to Authorize Agent (If applicable)
4. Written Statement - explaining basis for appeal.
5. Third Party Notice of Appeal (If applicable)
6. Decision: A copy of the decision being appealed
Checklist of Submittal Requirements
Applicant
Initials
Intake
Initials
Requirements
1 Fee Payment
2 Application
3 Affidavit to Authorize Agent (If applicable)
4 Written Statement
5 Third Party Notice of Appeal (If applicable)
6 Decision (copy of the decision being appealed)
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APPEALS OF ADMINISTRATIVE DECISIONS (Hillsborough County)

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Completed 22 August 2020

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