Fillable Department of Growth Management (Lake County Board of County Commissioners)

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Department of Growth Management (Lake County Board of County Commissioners)

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File type: PDF

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

BROWSE LAKE COUNTY BOARD OF COUNTY COMMISSIONERS (FL) FORMS

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Department of
Growth Management
Sign Zoning Clearance/Permit
Sign Zoning Clearance/Permit-CS25 Page 1 of 2
DATE ALT. KEY ADDRESS SCREEN NO. __________________
OWNER'S NAME PHONE
OWNER'S ADDRESS (MAILING):
Street City Zip Code
PROJECT ADDRESS
Street City Zip Code
LEGAL DESCRIPTION: (Attach Property Record Card) Section Township Range _________
Subdivision Phase Lot Block
DIRECTIONS TO PROPERTY:
EXISTING SITE DEVELOPMENT
SIGN: ____GROUND ____WALL PROJECT NAME: ___________________________JOB VALUE
$
Number of Signs Height of Sign(s)
Sign Area: Wall Sign(s) per plan attached
Ground Sign(s) per plan attached single faced or double faced
Please attach a scaled plot plan and identify square footage of sign(s)
The issuance of this permit does not authorize any person to violate applicable Lake County Codes. All signs
require permits. Sign regulations are intended to complement the building and electrical codes adopted by Lake
County. Replacement signs may require a field inspection prior to issuance of permit. Refer to Chapter XI, of the
Land Development Regulations. This information can be found online at
www.municode.com.
FEE SIMPLE TITLEHOLDER AND ADDRESS (IF OTHER THAN OWNER)
CONTRACTOR'S NAME PHONE
CONTRACTOR'S ADDRESS
CONTACT PERSON PHONE
ARCHITECT/ENGINEER'S NAME/ADDRESS/PHONE
BONDING COMPANY AND ADDRESS
MORTGAGE LENDER’S NAME AND ADDRESS:
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in
compliance with all applicable laws regulating construction and development, and the building is designed per code-
mandated wind load design.
Department of Growth Management
Sign Zoning Clearance/Permit
Sign Zoning Clearance/Permit-CS25 Page 2 of 2
WARNING TO OWNER: Your failure to record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the job site before the
first inspection. If you intend to obtain financing, consult with your lender or an attorney before commencing work or
recording your Notice of Commencement. The issuance of a building permit does not assure the building setbacks
have been met or that the structure does not encroach on an easement. The owner and/or contractor have the sole
responsibility of determining compliance with setbacks and non-encroachment of easements. If the County
determines the structure does not meet applicable setbacks or improperly encroaches on an easement, the owner is
responsible for moving the structure, restoring the easement to its original condition, or otherwise making the structure
comply with County setbacks and other land use requirements.
OWNER'S OR CONTRACTOR’S SIGNATURE CONTRACTOR’S CERTIFIED/REGISTERED NO.
The foregoing instrument was acknowledged before me this _____ day of ________________________________,
20_______, by ____________________________________________________________ who is personally
known to me or has produced _____________________________________________ as identification.
Notary Public
SUBCONTRACTOR:
Electrician License #
To be completed by Staff
Application #: ______________ Address #: ________________ Site Plan No. ________________ AR#:______________
Landscaping Required ____________ Zoning District _ Future Land Use Category ___________________
Green Swamp ACSC ______ If Yes, date mailed to DCA: _______________ Wekiva RP Area _____ Comm. Dist. #_______
Wetlands/Water Body ______ Wetland Affidavit ______ Flood Map Page ________ ED _________ Flood Permit ________
Census Tract _________ Lot Size: _____________ Sign Road No. ______________ New Sign _____ Replacement______
Setbacks: Front ___________________ 2nd Front __________________ Side ______________ Rear _________________
Comments: __________________________________________________________________________________________
____________________________________________________________________________________________________
This application and associated plot plan have been reviewed for compliance with the Lake County Comprehensive Plan and Land
Development Regulations.
Approved by Date
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Department of Growth Management (Lake County Board of County Commissioners)

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Completed 18 July 2020

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