Fillable DREDGE AND FILL PERMIT APPLICATION PINELLAS COUNTY WATER (Pinellas County Clerk of the Circuit Court and Comptroller)

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DREDGE AND FILL PERMIT APPLICATION PINELLAS COUNTY WATER (Pinellas County Clerk of the Circuit Court and Comptroller)

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BROWSE PINELLAS COUNTY CLERK OF THE CIRCUIT COURT AND COMPTROLLER FORMS

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Direct all correspondence to:
Clerk, Water and Navigation, 5
th
Floor Application # ____________________________
315 Court Street (OFFICIAL USE ONLY)
Clearwater, FL 33756
DREDGE AND FILL PERMIT APPLICATION
PINELLAS COUNTY WATER AND NAVIGATION
I. PROPERTY OWNER INFORMATION:
A. Applicant’s Name: __________________________________________________________________________
B. Mailing Address: ___________________________________________________________________________
City: ____________________________________________ State: __________ Zip: ___________________
C. Telephone No: __________________________ E-mail Address: _____________________________________
II. AGENT INFORMATION:
A. Name: ____________________________________________________________________________________
B. Address: ___________________________________________________________________________________
City: _____________________________________________ State: ___________ Zip: ___________________
C. Telephone No: __________________________ E-mail Address: _____________________________________
III. SITE INFORMATION:
A. Construction Site Address: ____________________________________________________________________
City: ____________________________________________ State: ____________ Zip: ___________________
B. Parcel ID Number: ______/______/______/__________________/______/______
C. Incorporated: Unincorporated: _________________________________________________
D. Affected Water Body: _______________________________________________________________________
E. Previous Permits: __________________________________________________________________________
F. Date applicant assumed property ownership: ____________________________________________________
month/year
G. Obstructions: (Dogs, Fences, etc.) _____________________________________________________________
H. Attach 8 ½” X 11” vicinity map showing specific project location.
I. All other information pursuant to Section 166-357, Pinellas County Code, as needed.
J. For projects requiring a public hearing, attach a copy of the complete legal description.
Application # ____________________________
(OFFICIAL USE ONLY)
IV. PROJECT DESCRIPTION: (attach additional sheets if necessary)
A. Fill:
Purpose: ____________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Type of material: _____________________________________________________________________
Dimensions: _____________________________________ Acres: _____________________________
Cubic Yards: above jurisdictional line: _______________________________________
below jurisdictional line: _______________________________________
Method of Containment: _______________________________________________________________
B. Dredge: New Maintenance
Purpose: ____________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Type of material: _____________________________________________________________________
Dredge Method: ______________________________________________________________________
Dimensions: ____________________________________ Acres: ______________________________
Cubic Yards: above jurisdictional line: _______________________________________
below jurisdictional line: _______________________________________
Method of Containment: _______________________________________________________________
Method and location of spoil disposition: __________________________________________________
V. CONTRACTOR INFORMATION:
I, ______________________________________________________________________, a certified contractor,
state that the project has not commenced and that it will be constructed in compliance with all requirements and
standards set forth in the Pinellas County Code, and in accordance with the attached drawings which accurately
represent all the information required to be furnished. In the event that this project is not completed in
accordance with the permit or the information furnished is not correct, I agree to correct the deficiency,
and/or restore the site to its preconstruction condition.
Signed: ______________________________________________________ Cert No.: ____________________
Company Name: _________________________________________ Telephone No: ____________________
City: _____________________________________________ State: ___________ Zip: _________________
E-mail Address: ____________________________________________________________________________
VI. OWNER’S SIGNATURE:
I hereby apply for a permit to do the above work and state that the same will be done according to the map or plan
attached hereto and made a part hereof, and agree to abide by the criteria of the Pinellas County Code for such
construction and, if said construction is within the corporate limits of a municipality, to first secure approval from
said municipality. I further state that said construction will be maintained in a safe condition at all times, should
this application be approved, that I am the legal owner of the upland from which I herein propose to construct the
improvements, and that the above stated agent/contractor may act as my representative. I understand that I, not
Pinellas County, am responsible for the accuracy of the information provided as part of this application and that it
is my responsibility to obtain any necessary permits and approvals applicable for the proposed activities on either
private or sovereign owned submerged land.
____________________ _________________________________________________________________
Date Legal Owner’s Signature
DREDGE / FILL
ENG. SCALE: 1” = SLOPE: Application # ___________________________
(OFFICIAL USE ONLY)
Profile View
Plan View
ENG. SCALE: 1” =
WATERWAY WIDTH __________
WATERFRONT WIDTH __________
N
SHORELINE
Municipality Approval Water and Navigation Approval Engineer’s Seal
Application # ____________________________
(OFFICIAL USE ONLY)
DISCLOSURE FORM
In order to alleviate any potential conflict of interest with Pinellas County staff, it is required that the County be
provided with a listing of PERSONS being party to a trust, corporation, or partnership, as well as anyone who may have
beneficial interest in the application which would be affected by any decision rendered by the County (attach additional
sheets if necessary).
A. PROPERTY OWNERS:
Name: ___________________________________ Name: ___________________________________
Address: _________________________________ Address: _________________________________
_________________________________ _________________________________
Name: ___________________________________ Name: ___________________________________
Address: _________________________________ Address: _________________________________
_________________________________ _________________________________
B. REPRESENTATIVES:
Name: ___________________________________ Name: ___________________________________
Address: _________________________________ Address: _________________________________
_________________________________ _________________________________
Name: ___________________________________ Name: ___________________________________
Address: _________________________________ Address: _________________________________
_________________________________ _________________________________
C. OTHER PERSONS HAVING OWNERSHIP INTEREST IN THE SUBJECT PROPERTY:
Interest is: contingent absolute
Name: _______________________________________ specific interest held: ___________________
__________________________________________________________________________________
D. DOES A CONTRACT FOR SALE EXIST FOR THE SUBJECT PROPERTY? YES NO
If so, the contract is: contingent absolute
Name of parties to the contract: ________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
E. DOES AN OPTION TO PURCHASE EXIST FOR THE SUBJECT PROPERTY? YES NO
Name of parties to the option: ____________________________________________________________
F. OWNER’S SIGNATURE:
I hereby certify that the information stated above is complete, accurate, and true to the best of my
knowledge.
X_______________________________________________ Date _______________________________
Consent to Use State-Owned Submerged Lands
DO YOU LIVE OR DO BUSINESS ON THE WATER?
If so, you may need authorization to use the lands under the water from the owners of those lands. This authorization is
in addition to any city, county, Florida Department of Environmental Protection, U.S. Army Corps of Engineers, or
Water Management District permit.
WHAT LANDS ARE WE TALKING ABOUT AND WHO OWNS THEM?
Sovereign submerged lands are all those submerged lands waterward of the ordinary or mean high water line under
navigable fresh and salt water bodies. The Governor and Cabinet, sitting as the Board of Trustees of the Internal
Improvement Trust Fund, hold title to all of those lands below navigable waters which have not been previously
conveyed into private ownership. Portions of these submerged lands have been designated as “aquatic preserves” and
because of their unique biological, aesthetic or scientific value, they are held and managed to a higher degree of care.
Since the State owns these lands, both public and private entities must obtain consent to use them.
WHY IS CONSENT NECESSARY AND BY WHAT AUTHORITY IS IT REQUIRED?
These lands are held in trust for the use and benefit of the people of the State, as set forth in the State Constitution;
therefore, the private use of these lands must be balanced with the need to conserve and protect the scientific value and
beauty of those lands. The intent of the regulations is to ensure that all sovereign submerged lands are managed
primarily for the propagation of fish and wildlife, and public recreation. The legislative origins of the procedures
employed in the review of applications to use sovereignty submerged lands are contained within Chapters 253 and 258
of the Florida Statutes. These statutes are implemented through rules which are contained within Chapters 18-14, 18-
18, 18-20 and 18-21 of the Florida Administrative Code. It is important to contact the Department of Environmental
Protection before you use these lands.
WHAT TYPE OF ACTIVITIES REQUIRE AUTHORIZATION?
Uses that require authorization must be approved before they are conducted. The most commonly requested uses are
the construction of docks, the placement of riprap, dredging for access or channels, mangrove trimming, bridge and
utility crossings, and beach renourishment projects.
WHAT DO YOU HAVE TO DO AND IS THERE A FEE?
The form of consent that is required depends upon the type of activity that is proposed. Forms of consent include
letters, easements, use agreements, management agreements, and leases. The type of activity proposed also determines
the amount of fees; however, commercial uses will always require payment of fees.
WHAT HAPPENS IF YOU DO NOT RECEIVE AUTHORIZATION TO USE THESE
LANDS?
Alterations to, or structures discovered on, sovereignty submerged lands without authorization are subject to lease fees
in arrears, with interest, and fines. In some cases, removal of structures may also be required.
WHO DO YOU CONTACT TO INQUIRE ABOUT THE USE OF THESE LANDS?
The Department of Environmental Protection Division of State Lands field office listed below.
Department of Environmental Protection
Southwest District
13051 N. Telecom Parkway
Temple Terrace, FL 33637
Phone: (813) 632-7600
Fax: (813) 632-7665
DREDGE/FILL
ENG.
SCALE:
1"
= 3' SLOPE: 2 ; 1
Application#
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Profile View
Plan
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P/L
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SHORELINE
Municipality
Approval
Water
and
Navigation
Approval
Engineer's
Seal
048/WD/ar1/ENVMGT/OrCCh6
4/26/94
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DREDGE AND FILL PERMIT APPLICATION PINELLAS COUNTY WATER (Pinellas County Clerk of the Circuit Court and Comptroller)

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Completed 10 February 2021

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