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BROWSE LAKE COUNTY BOARD OF COUNTY COMMISSIONERS (FL) FORMS

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-•~---
LJltKE
COUNTY,
FL
REAL
FLORIDA
· REAL CLOSE
Office of
Planning and Zoning
Development Application
Major Site Plan
Master Park Plan
Minor Site Plan
Major Site Plan
Master Park Plan
Minor Site Plan
Amendment
Amendment
Amendment
Preliminary Plat
Mining Operating Permit
Landscape Plan/Review Only
Tree Removal
Small Minor Site Plan, No Vertical or 200 Square Feet or Less
You have the option to request a Development Review Staff (DRS) meeting or written comments only. Please
check which one you would prefer. _____ DRS meeting requested _____ Written comments only
If you are constructing a Green building, if your development is an affordable housing project or within the
Lake County Enterprise Zone, please let us know.
1. Project Name: ________________________________________ Alternate Key#:
2. Description of proposed development:
3. Location of proposed development:
4. Number of jobs to be created:
5. Owner’s Name:
Mailing Address:
Telephone Number: Fax Number:
E-mail:
6. Applicant’s Name:
Mailing Address:
Telephone Number: Fax Number:
E-mail:
7. Developer’s Name: _______________________________ Contact Person:
Mailing Address:
Telephone Number: Fax Number:
E-mail:
8. Engineering Firm: _______________________________ Contact Person:
Mailing Address:
Telephone Number: Fax Number:
E-mail:
9. Has any previous application or variance been filed in connection with this property?
If yes, please describe the details of the application and case number:
Office of Planning & Zoning
Development Application
Revised 2018/04
Page 1 of 6
Development Application
10. Water and Sewer will be provided by:
Note: Utility provider documentation required.
11. For Major Site Plan, Minor Site Plan, Preliminary Plat, Master Park Plan, and Mixed Used Projects: A buffer
must be submitted identifying all properties within 300 feet of the property to be developed. The use of the
neighboring properties must be identified. A noise study, including a noise mitigation plan, shall be required if
the surrounding property uses are different, based on the use classifications listed in the Land Development
Regulations (3.01.03).
12. Will the infrastructure be installed prior to approval of the final plat? ____Yes _____ No ____N/A
13. Will you be adding a well on this site?
14. Site Development Data: Existing Proposed
a. Total gross acreage: ________ ________
b. Total net acreage: ________ ________
c. Number of lots: ________ ________
d. Commercial square footage: ________ ________
e. Total number of dwelling units ________ ________
f. Projected density: ________ ________
g. Total acres in park: ________ ________
h. Total acres in recreation: ________ ________
i. Total acreage in easements/right-of-way ________ ________
j. Total acreage in floodplain: ________ ________
k. Total acreage in wetlands: ________ ________
l. Construction acreage: ________ ________
m. Total caliper of protected trees removed or to be removed:
Caliper
Total
Mitigation
Percentage
SUBTOTAL
REQUIRED
times (X) 0.50
times (X) 0.50
times (X) 0.50
times (X) 1.00
times (X) 2.50
times (X) 2.00
Per tree type
Per above
Justification for tree removal:
Office of Planning & Zoning Revised 2018/04
Development Application Page 2 of 6
Development Application
15. Are you going to build a new driveway or modify an existing driveway? ____Yes _____ No ____N/A
If yes, please provide the information. Road Name
County Road Maintenance Number (if known) ____________ Section _____ Township _____ Range _____
a. A separate application may be required for each road.
b. Construction details (1-set) drawn to scale, including a general location map.
c. If turn lane construction is required applicant shall install Portable Changeable (Variable) Message
Signs (PCM’s, FDOT Index 6740) on the County Road(s) impacted by construction. The PCM’s shall
be installed one (1) week prior to construction in order to inform residents and roadway users of the
impending construction. The PCM’s shall display lane closure information including anticipated lanes
to be closed, extent of lane closure (i.e. ‘Next 3 miles’), daily hours of closure, and temporary restrictions.
d. If turn lane construction is required, submittal shall also include:
1. Turn lane(s) layout with dimensions;
2. Striping plan with typical pavement section;
3. Traffic maintenance plan;
4. Record survey of right-of-way signed and sealed by a Florida licensed surveyor.
e. All turn lane improvements shall be overlaid from taper to taper, full width.
f. If a culvert is required all right-of-way disturbed by this work shall be restored to its original condition
and in accordance with applicable Lake County Codes. All disturbed areas must be sodded, matching
existing grass type. Applicant shall be responsible for sod until it is established.
g. In areas where sidewalks are present or planned, the driveway must include a minimum 4 foot wide
path traversing the driveway apron (at a maximum 2% cross slope) in compliance with ADA
requirements.
h. Driveway connection shall be a minimum of three hundred (300) feet from any intersection.
i. Prior to construction, Applicant shall provide written notice to all residences adjacent to the project limits.
Within a minimum of fourteen (14) calendar days prior to construction, applicant shall provide to Lake
County Public Works a copy of the notification with a list of parties notified. This notice shall include the
anticipated construction schedule, maintenance of traffic plan, and any impacts (permanent or
temporary) to the subject residence and adjacent area.
j. Driveway connection and roadway construction must be completed in accordance with the approved
site plan and/or subdivision construction plans. Lake County reserves the right to modify the permitted
driveway(s) at any time including median, turn lane, or other modifications within County right of way.
The Applicant will not receive compensation or compensatory damages relating to such modification by
Lake County.
k. Issuance of a driveway permit does not vest any rights to the property for zoning, land use changes, or
site improvements. The owner must follow all County procedures for permitting of the commercial, retail
or other land uses.
Office of Planning & Zoning Revised 2018/04
Development Application Page 3 of 6
_______ __
Development Application
Information:
You can contact the Office of Building Services for building, electric, plumbing, and mechanical code
requirements, please call (352) 343-9653 for assistance.
Please contact the Communication Technologies Division for subdivision and road name approval; their phone
numbers are (352) 253-1818.
If the legal description shown on the warranty deed is not correct or does not close you may be required to submit
a boundary survey or sketch of description of the property, certified by a professional land surveyor. The legal
description should appear on the face of the survey or description.
For a list of submittal requirements, please refer to the applicable Submittal Requirement Checklist, which is
attached to this document.
TO BE COMPLETED BY STAFF:
Verbal Pre-submittal Project# ___________________
Project #: ____________________ AR # ___________________ Date: ____________________
Existing zoning: ___________________ Future Land Use Category: _________________________
Section: _____ Township: ______ Range: ______ Commissioner District: _____________________
Planning Area: ________________________ Utility Area: _________________________________
Tree Removal Permit only: Approved Denied Expiration Date: ________
Authorized Staff Signature Date
If this application meets criteria for RAPID review; please expedite.
Office of Planning & Zoning Revised 2018/04
Development Application Page 4 of 6
click to sign
signature
click to edit
_______________________________________
______________________________
______________________________
Development Application
OWNER'S AFFIDAVIT
STATE OF FLORIDA
COUNTY OF LAKE
BEFORE ME, the undersigned authority personally appeared _________________________________,
who being by me first duly sworn on oath, deposes and says:
1. That he/she is the fee-simple owner of the property legally described and attached to this
application.
2. That he/she desires a Development Approval to accomplish the above desired request, as stated
on Page One of this Application.
3. That he/she has appointed ___________________________________ to act as Agent and/or
Applicant in their behalf to accomplish the above.
4. Permission is granted for staff to conduct a site visit for purposes of review of this site plan or
development plan.
(Owner's Signature)
STATE OF FLORIDA
COUNTY OF LAKE
The foregoing instrument was acknowledged before me this ________ day of _________________, 20________, by
, who is personally known to me or who has
produced _ as identification and who did ________ or did not ________ take an oath.
Notary Public (Signature)
(SEAL)
My Commission Expires:
NOTE: All Applications shall be signed by the Owner(s) of the Property, or some person duly authorized by the
Owner to sign. The authority authorizing such person other than the Owner to sign MUST be attached.
Office of Planning & Zoning Revised 2018/04
Development Application Page 5 of 6
click to sign
signature
click to edit
_______________________________________
______________________________
______________________________
Development Application
AGENT/APPLICANT'S AFFIDAVIT
STATE OF FLORIDA
COUNTY OF LAKE
BEFORE ME, the undersigned authority personally appeared _________________________________,
who being first duly sworn on oath, deposes and says:
1. That he/she Affirms and Certifies that he/she understands and will comply with all Ordinances,
Regulations, and Provisions of Lake County, and that all statements and diagrams submitted herewith
and attached hereto, are true and accurate to the best of their knowledge and belief, and further, that this
application and attachments shall become part of the Official Records of Lake County, Florida, and are
Not Returnable.
2. That he/she desires a Development Approval for the use of property as proposed, for the property
legally described on this Application.
3. That the submittal requirements for this Application, which are attached hereto, have been completed and
attached hereto as part of this Application.
(Agent / Applicant's Signature)
STATE OF FLORIDA
COUNTY OF LAKE
The foregoing instrument was acknowledged before me this ________ day of _________________, 20________, by
, who is personally known to me or who has
produced as identification and who did ________ or did not ________ take an oath.
Notary Public (Signature)
(SEAL)
My Commission Expires:
Office of Planning & Zoning Revised 2018/04
Development Application Page 6 of 6
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Completed 18 July 2020

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