Office of
Planning and Zoning
Utility Notification
Office of Planning & Zoning Revised 2017/10
Utility Notification Page 1 of 1
To be completed by County staff: Staff Name:___________________________________________
In an effort to assure governmental cooperation and assistance in the use of approved utility facilities,
Lake County shall, per Land Development Regulations, Section 6.12.00, require connection to those
facilities upon development, within 1,000 feet of an approved central sewage system and/or within 300
feet of an approved central water system.
The owner of the following property has either a pending public hearing, commercial project under review
or is in the process of obtaining a permit. It is understood that a one-day turn around for this information
is required so that delays for issuance will be minimized.
Please acknowledge the availability to serve the following property with central utility systems.
The applicant is proposing the following:
Single-Family Dwelling ________ Multi-Family Units ________ Duplex ________ Commercial ________
Administrative Lot Split __________ Commercial Project___________ Rezoning_________
Legal description: Section ______ Township ______ Range ______ Alt Key # _________________
Subdivision ______________________ Lot _______ Block _______ Additional Legal attached ______
Hook up to Central Sewage _______________ within 1,000 feet of the above described property.
(is or is not)
Hook up to Central Water _________________ within 300 feet of the above described property.
(is or is not)
The City of _________________________________, will provide immediate hook up to this property for:
Central Sewage: Yes _____ No _____ Central Water: Yes _____ No _____
Will the connection to the central sewage system be via a ____gravity line or a ____force main/pump?
Wellfield Protection:
To protect the principal source of water in Lake County, per section 6.03.00 of the Land Development
Regulations, the area within 1,000 feet radius shall be considered a wellhead protection area.
This property is____ or is not____ within 1,000 feet of an existing or future wellhead.
Please attach any conditions that affect the availability of provision of service to this property.
City Official or Private Provider Signature _________________________________________________
Print Name and Title:______________________________________________Date _______________
Please return this completed form to the Office of Planning & Zoning via facsimile to (352) 343-
9767, or email it to zoning@lakecountyfl.gov.
Date Received: _______________ Address #: ____________________ Project Name:__________________
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