DHR Compliance Review State Lands Consultation Form
Mail To: Robin Jackson
Bureau of Historic Preservation
R.A. Gray Building, MS 8
500 S. Bronough Street
Tallahassee, Florida 32399-0250
Or
From:
Address:
Email:
Email To: Robin.Jackson@DOS.myflorida.com Date:
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Would you like your response letter emailed to you? Yes
No
Management Area: ______________________________________________________________
Township: _______ Range: _______ Section: _______ County: ____________________
Lat: _________Long: _________ / Address ___________________________________________
Project Name: __________________________________________________________________
Project Description:
Attach supplemental pages with additional information if needed. Please include the following
relevant documents: map/aerial image of the project location with area(s) of proposed
ground disturbance clearly labeled, site plan, architectural plans, building photographs and
date of construction, Florida Master Site File Numbers for recorded resources.
Florida Park Service Only send to:
cc: Bureau of Natural and Cultural Resources, 3900 Commonwealth Boulevard, MS 530,
Tallahassee, Florida 32399-3000.
William Stanton 850-245-3110, William.Stanton@dep.state.fl.us.
