St. Johns County Growth Management Department
City State Zip Code
Zip CodeCity State
Are there any owners not listed?
I understand that reasonable inspections of the subject property may be made as part of the application review process. I understand
that any material misrepresentations or errors contained in this application or supporting documents may void an approved
application, at the reasonable determination of the County considering the Land Development Code, Comprehensive Plan, and other
I HEREBY CERTIFY THAT ALL INFORMATION IS CORRECT:
Signature of owner or person authorized to represent this application:
Printed or typed name(s)
Property Tax ID No
Major Access Size of Property
Future Land Use Designation
Overlay District (if applicable)
Water & Sewer Provider
Present Use of Property
Please list any applications currently under review or recently approved which may assist in the review of this application including
the name of the PUD/PRD:
Revised August 24, 2015
If yes please provide information on separate sheet.
Project Description (use separate sheet if necessary)
Cleared Acres (if applicable)
No. of lots (if applicable)
Proposed Bldg. S.F.