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COUNTY, FL (Lake County Board of County Commissioners)

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U.S.A. forms for Lake County Board of County Commissioners

BROWSE LAKE COUNTY BOARD OF COUNTY COMMISSIONERS (FL) FORMS

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COUNTY,
FL
REAL
FLORIDA·
R
EAL
CLO
SE
___________________________________________________________________________________
_____________________________________ ____________________________________
____________________________________
Office of
Planning and Zoning
Special Event Site Plan
Date: ______________________________
List all Owner(s) of the property: _________________________________________________________
Address: ___________________________________________________Phone No. _______________
Agent’s Name: ______________________________________________________________________
Address: ___________________________________________________________________________
Phone No.: ______________________ Email Address: ______________________________________
Operator’s Name: ____________________________________________________________________
Address: ___________________________________________________________________________
Phone No.: ______________________ Email Address: ______________________________________
Site address of gathering/special event: ___________________________________________________
Date(s) and time of the gathering/special event: ___________________ ___
What is the purpose of the gathering/special event: __________________________________________
How many people will be attending: _______________
Please indicate if any of the following criteria apply to the event:
Use of Portable Restrooms
Temporary Road Closure*
Pyrotechnics*
Tent or Temporary Structures
* Please be advised that temporary road closures, pyrotechnics, or attendance by more than 500 person(s) will require the
submission of a Special Event Permit Application.
Owner or Agent’s Signature Owner or Agent’s Signature
State of Florida
County of Lake
Sworn to (or affirmed) and subscribed before me by means of □ physical presence or □ online notarization,
this day of , 2020, by
.
Personally Known OR Produced Identification
Type of Identification Produced _______________________________
Notary Signature
(SEAL)
Office of Planning & Zoning Revised 2020/09
Special Event Site Plan Page 1 of 2
_______________________________________________________________________________
___________________________________ _________________________________________
Special Event Site Plan
The following items must be submitted with the Special Event Site Plan**:
A letter from the property owner giving permission for use of the property and indicating that sanitary
facilities are available.
If portable sanitary facilities are being used; please provide a copy of the contract with the company
you are renting the portable units from.
A plot plan that shows the location of all existing structures, septic tank, drainfields and wells,
wetlands and water bodies, and the location of all proposed temporary structures, parking areas,
sanitary facilities, event areas and ingress/egress points.
If a tent(s) is used, provide proof that the tent(s) is fire retardant.
A fee of $100.00
** The Special Event Site Plan Application must be submitted no later than 30 days from the event date.
To be completed by County staff: Fee: $100.00 (SEP)
Special Event Site Plan #____________ Address #:__________ Alt. Key #:__________________
Zoning:____________________ Use of site approved: _______Yes _______No
Do proposed signs comply with LDRs: _____Yes _____No ______ N/A
Do the temporary structures meet the setbacks: ______Yes ______No _______ N/A
Environmental Health review required: ___Yes ___ No.
If yes, ____________________________________________________ Date: _________________
(name and signature of staff person)
Public Works review required: ___Yes ____No.
If yes, ____________________________________________________ Date: _________________
(name and signature of staff person)
Public Safety review required: ___Yes or ___No
If yes, ___________________________________________________ Date: _________________
(name and signature of staff person)
Sheriff’s Department notified ___Yes or ___No. If yes, name of contact: ______________________
Staff notes:______________________________________________________________________
Name and Title of Planning and Zoning Staff Signature of Staff Date
Office of Planning & Zoning Revised 2020/09
Special Event Site Plan Page 2 of 2
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COUNTY, FL (Lake County Board of County Commissioners)

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Completed 22 January 2021

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