HomeMy WebLinkAboutApplication for Outdoor Advertising PermitSTATE OF FLORIDA DEPARTMENT OF TRANSPORTATION
APPLICATION FOR OUTDOOR ADVERTISING PERMIT
(THIS PAGE FOR DEPARTMENT OF TRANSPORTATION USE ONLY)
11. Applicant: N1 �� �II`� 1�++� I ZAI li ODAIMS Appli bon #:
12, Date/time rec'd by District: 1 ' n�.7 -Q� By: ►`
13. Is application being submitted as result of a notice of violation? Yes No
If yes, Notice # and DOT Case #, if applicable: `?a — A / S
14. Are existing permits being cancelled: _ Yes x No For vegetation management? _ Yes No
(If yes, applicant must submit Cancellation Certification to the District office with this permit application.)
15. State road M.-SR 9 I Type highway: Interstate FAP -& Se
16. Urban area? Yes 17. Incorporated? Yes 18. Within city? Yes
No No NO
19. Land Use: Zoned oomm.lnd. Unzoned commAnd. 1�c Other ^&
If unzoned, name of three businesses: 1. 2. 3•
Distances of businesses from each other: 1-2 2-3 3-1
LOCATION INFORMATION n
County name: T + /E County number. '7
RCI Section: 9 q q -7 =) Direction: IV Q 9 Milepost: +
Side of section: R 1 Sign read: LHR -�• = RHR Per
RCI reference feature: GI Distance from feature: .5 !" I . Direction: 3
20. Inspector's name: ?— Date location inspected:
!
21. Distance from nearest permitted location (same side of highway):_'�
SIGN INFORMATION
Facing height: Facing width: Structure height (above crown of road): 1
HAGL: (n Distance off RNV:
Is sign being permitted as nonconforming: Yes _ No
5
FORM 575-070-04
RIGHT OF WAY
OGc • 11199
PAGE 2 OF 3
idary' (SHS) I m
A" lipp cation r Approved„ Denied Intent to Permit (V Ig.Mgmt.)
Signature of Inspector:
Date:
�—
Signature of ODA Administrator.
Date: t
Central Office approval:
Date: / -2- :2 �n o
For FOOT District Use Only:
_ <� kr<� c
30 day posting date deadline:
K.� 3���Post�edYe �fNa Photo taker~? ,—es —.:No
�•�k�° x 'skNotice # :s5
Field checked on (Date):
, ...
270 day build date deadline:
y BURU Yes F No ' ' Photo taken:, _Yes _ No
Field •
.. WBy'�3�� xoU"#; s
checked on (Date): . ..
For FOOT Central Office Use Only:
Date rec'd from District:: 1 A- as - o o
Facing M Structure M
Rec't N �e Date entered O.DAJMS: 1 a a-7 - 00 By;
Dae
Certified Mail #: Ooai
I
IY 09
F
_ G� FORM 57$070•04
D 0 ( Y- -(j Q RIGHT OF WAY
OGC * "M
STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION PAGE 1 OF 3
APPUCATiON FOR OUTDOOR ADVERTISING PERMlT
(A) APPLICANT INFORMATION: (If you currently hold a State of Florida outdoor advertising license or permits, please enter the name, address and account
number on file with the Department.) PLEASE TYPE OR FILL OUT IN INK. APPLICATIONS SUBMITTED IN PENCIL WILL BE RETURNED. For assistan
completing this form, please call (850) 414.4545. ce In
t. Name of Applicant or Company: MEDIANET, INC.
2. FOOT Account Number. VF593468951001
If new account, Federal Tax ID #_ N/A Or Social Security # N/A
3. Address of record (for billing purposes and legal notices): P - 0 . BOX 2001
City/State/zipCode: MINNEOLA FLORIDA 34755
4. Mailing address for permit tag (if different from above): SAME AS ABOVE
(B) LOCATION INFORMATION:
1. County: ST. LUCIE �•=-� N
(Property Max ID#�'. �-
3. X Proposed Location _ Existing sign: Is located on: State Road #: 9 1 _ US Route #:
N/A Local name 8 Number: FLORIDAFLOR I TURNPIKE
9 8,4/10 miles ❑ feet NORTH of OKEECHOBEE ROAD SI nwill bells on the N
Barest ntersect on g side of the highway,
EAST (�Er)
facing
(N.E.S,W.)
4. Distance of closest part of sign to edge of right of way. 25 FEET
S. Name of existing business within 800' and on same side of highway as sign location: 1. N/A
Names of 2 other businesses within 1600' of business named above, 2. N/A 3. N/A
Distances of businesses from each other: 1.2 N/A 2-3 N/A 3-1 N/A
6. Do you own or LE AS E lease site? If lease, name of landowner: OLC , INC.
7. Method of marking location: L Stake/flag !Painted pavement —Other (describe) SEE PHOTO
(C) SIGN DESCRIPTION:
1. Facing height: 10' — 6" Facing width: 3 6 Total Sq.Ft.: 3 7 8 2. Changeable facing? Yes X No
3. Height Above Ground Level: 4 6 1 4. Sign structure Height: 501 5. # of poles: 1
6. Material used for: Sign facing: METAL Supports: METAL
7. Configuration of sign: X{ V-shape _ Back -to -Back _ Side-by-slde Single faced
8. Will d2 } Aa p�rtr7�o—j,
9. Will uttir H lrZNg"E'D t
If the anster is 'Yes,* a Management Plan
Permit to numb�bra�cefletYl�
Jo If yes, describe lighting: 400 WATT HOLOPHANE FIXTURES ON CATWALK
on late right of way be required to create a viewing zone for this sign? Yes X No
m t be approved by the Department and the permits for two nonconforming signs cancelled.
N A
10. Is a� existing permit being cancelled as condition of Issuance of this permit other than for vegetation management? _Yes X No
If yes, Pe mil 14�1'eft1�4194Nt?tl /A
NOTE: I F - --" "" OR EITHER 15. OR 16., ABOVE, SUBMIT THE CANCELLATION CERTIFICATION TO THE DISTRICT OFFICE
WITH THIS PERMIT APPLICATION. IF THE NEW APPLICATION IS NOT APPROVED, THE PERMIT(S) WILL NOT BE CANCELLED.
XREQUIRED ATTACHMENTS (Application will be returned as Incomplete If required attachments are not submitted with the application- see instructions)
laroownor AuTOIZatxa1 X Location Sketch: XLocal Govwm*nt zarinp4.and Use Verifiol,6m; X Locd Goverrvstenl bta7Qutp permit, a eQu viler t Pholar+ph d alto
trio.. o n n one ?par 1a1p sing can
Ls inp vegetation; XAppliication lee. PLEASE NOTE: If you do not axrently hold. an OuW=Advertlsirtp Umr*% maybe necessary or
feu w otxan one balers a parrot on be issued.
NOTARIZATION AND CERTIFICATION
I. DANI EL L . CHOLAKy eenhry that the Information given and the statements made In this application us true and that I have received, in writing.
landowner or other g permission1Ioffrom the
person in lawful possession of the site W creel an outdoor advertising sign at the location designated in the application. 1 understand this submission •of fags or misleading
information on this application, or any other violation of Chaplet 479, Florida Statutes, or Chapter 14.10. F.A.C.. may result in revocation of this permit. I further understand that the metal permit
tat must be posted at the sign site wtthtn 30 ys of issuance and the completed sign as described in this application must be built within 270 days of permit issuance or this permit is VOID.
� t /U—� PRESIDENT
Signa:urt of applicant Position in Company if applicable
Sworn and subscribed before me this, day or l.%-1-yy."y.,�.. 9y o��
tN 'me of &Runt). SAu is personally known to me or has produced�t (r 7 fl C Sd CtJ
Sate of
Signuure of oury. mycommission Expires: I 1p3 ((13
is
KELUE IVEY
MY COMMISSION if CC 800VP '
EXPIRES: January 3, 2003
F0RM575-070-04
RIGHT OF WAY
OGc -tIm
PAGE 2 OF 3
STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION
APPLICATION FOR OUTDOOR ADVERTISING PERMIT
(THIS PAGE FOR DEPARTMENT OF TRANSPORTATION USE ONLY) I I
11, Applicant: /►t,t D�%C_ IA/I 1C �ODAIMSAppli On #: 2 r Z
12. Dateltime rec'd by District: ) (- D :2 -66' 1 By;
13. Is application being submitted as result of a notice of violation? Yes x No
If yes, Notice #and DOT Case #, if applicable:
(ja./-5—
14. Are existing permits being cancelled: _ Yes No For vegetation management? _ Yes _ No
Current tag #(s):
(If yes, applicant must submit Cancellation Certification to the District office with this permit application.)
15. State road #: <591 (l�%2/t�P! K �^ Type highway: Interstate FAP Secondary (SHS)
16. Urban area? Yes 17. Incorporated? Yes 18. Within city? _ Yes
�No No � ��
19. Land Use: Zoned comm.find. Unzoned comm.And. —4 Other /'t& S
If unzoned, name of three businesses: 1. 2. 3•
Distances of businesses from each other: 1-2 2-3 3-1
LOCATION INFORMATION n
County name: Wei I: County number. 7 U
9gy7� r-tl
RCI Section: Direcfon: %� Milepost: oz '1 , oZ3
Side of section: I �^�`� f Sign read: LHR RHR Par I
RCI reference feature-.CdL Distance from feature: 5 r% Direction: s� LoJ N
20. Inspector's name: zQ - ) Date location inspected:
21. Distance from nearest permitted location (same side of highway): f
I
SIGN INFORMATION /
Facing height: Facing width: -211, Structure height (above crown of road):
i
HAGL: o / Distance off RIW:
Is sign being permitted as nonconforming: Yes _ No
�AliicAtien Approv4ed Denied Intent to Permit (Veg.Mgmt.)
Signature of Inspector: Date: (a 6n
Signature of ODA Administrator: Date:
�
O- / 2 / tro
Central Office approval: � Date: -7 , I
For FDOT District Use Only: w
30-day posting date deadline: osted `l�ey5 Nod"� Photo�t�ay(cen? _Yes No
y
Field checked on (Date): ryhxByPA
No(ice #
��
��x'BIit? es s No Photo taken: Yes _ No
270-day build date deadline: r z K I
Field checked on,(Date): 'k '' Noticed.
For FDOT Central Office Use Only: I
Date rec'd from District:: Facing #: Structure #:
Rec'tNumber. Date entered-ODA-IMS:-s-1A"3L%- H I B,
I
i
Certified Mail #: ?no 0 0 b oo ooa? / S 0 5 �-23 L
� J J
- _ I
1 � 7
FORM 575-070-a
RIGHT OF WAY
%O C) — Q OGC • I IM
STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION PAGE 1 of 3
APPUCAT)ON FOR OUTDOOR ADVERTISING PERMIT
[A) APPLICANT INFORMATION: (If you currently hold a State of Florida outdoor advertising license or permits, please enter the name, address and account
number on rile with the Department.) PLEASE TYPE OR FILL OUT IN INK. APPLICATIONS SUBMITTED IN PENCIL WILL BE RETURNED. For assistance in
completing this form, please call (850) 414.4545,
1. Name of Applicant or Company: MEDI ANET, INC.
2. FOOT Account Number: V F 5 9 3 4 6 8 9 510 01
If new account, Federal Tax ID # N/A Or Social Security # N/A
3. Address of record (for billing purposes and legal notices): P.O. BOX 2001
City/State/zipCode: MINNEOLA, FLORIDA 34755
4. Mailing address for permit tag (if different from above): SAME AS ABOVE
(B) LOCATION INFORMATION:
1. County: S T . LUC I E 2.1 Proper rax �D 12} 6, 3 3,+�3 i00 00 I0 2 01®,
3. X Proposed Location FI.;OR I DA
_ Existing sign: Is located on: State Road #: 9 1 US Route #: N/A Local name & Number: TURNPIKE
& 4/10 Xmiles o feet NORTH of OKEECHOBEE ROAD Sign will be/Is on the N side of the highway,
WEST ��� Nearest Intersect on (WETW.)
facing (N.E.S.W.) 4. Distance of closest part of sign to edge of right of way: 25 FEET
5. Name of existing business within 800' and on same side of highway as sign location: 1. N/A
Names of 2 other businesses within 1600' of business named above. 2. N/ A 3 N/A
Distances of businesses from each other: 1-2 N/A 2.3 N/A 3-1 N/A
6. Do you own or LE AS E lease site? If lease, name of landowner: OLC , INC.
7. Method of marking location: L Stake/flag X Painted pavement —Other (describe) SEE PHOTO
(C) SIGN DESCRIPTION:
1. Facing height: lot— 6 it Facing width: 3 6 I
3. Height Above Ground Level: 461
6. Material used for: Sign facing: METAL
7, Configuration of sign: X V-shape _ Back -to -Back
8, Will sign be lighted? _X Yes _ No If yes, des
Total Sq.Ft.: 3 7 8 2.
4. Sign structure Height: 5 0 t
Supports: METAL
Changeable facing? Yes X No
5. # of poles: 1
_ Side -by -side _ Single faced
tribe lighting: 400 WATT HOLOPHANE FIXTURES ON CATWALK
9. Will cutting or trimming of vegetation on Slate right of way be required to create a viewing zone for this sign? Yes X No
If the answer is "Yes,' a Management Plan must be approved by the Department and the permits for two nonconforming signs cancelled.
Permit tag numbers to be cancelled: N/A
10. Is an existing permit being cancelled as a condition of Issuance of this permit other than for vegetation management? _ Yes --L No
If yes, permit tag number to be cancelled: N/A
NOTE: IF A PERMIT IS BEING CANCELLED FOR EITHER 15. OR 16., ABOVE, SUBMIT THE CANCELLATION CERTIFICATION TO THE DISTRICT OFFICE
WITH THIS PERMIT APPLICATION. IF THE NEW APPLICATION IS NOT APPROVED, THE PERMIT(S) WILL NOT BE CANCELLED.
REQUIRED ATTACHMENTS (Application will be returned as Incomplete if required attachments are not submitted with the application- see instructions)
X W00 vnor Auehortz bw: X Location Sketch: XLocaf Govertment ZorivLand Use verification: X Local Government building pemh L or wrivelent: X Photograph of sib
910-^v5 rnark ngs (por [13M ana unrcunding vegetation: XApplication fee. PLEASE NOTE: 0 you do not currently hob an Outdoor Advertising License, it may be necessary b r
yov a oobn one before a po rrit can be iswed.
NOTARIZATION AND CERTIFICATION
I, uruv 1 GU I.J. k.XIVJ.,rGjjbby certify that the information given and the statements made in this application are true and that I have received. In writing, permission from the
Isndowner or Other person in lawful possession orthe site to erect an outdoor advertising sign at the location designated in the application. 1 understand that submission'of false or misleading
information on this application, or any other violation of Chapter 479. Florida Statutes, or Chapter 14.10. F.A.C., may result in revocation or this permit. I further understand that the metal permit
tag mua��N^d i� sig�withi�s of issuance d the completed sign as described in this lication must be built within 170 days of rmit issuance or this
D in application Y Pe permit is VOID.
PRESIDENT
Signature of applicant Position in Company, if applicable
Sworn and subscribed before me this day of (_ -j
(Name of arrlantl. S/he it�+ p/erssonally known to me or has produced
Statc of /; �.. t ,, , , ) ,-.
Signature of
Printed
NOV 2 2 2000
KELLIE IVEY
MY COMMISSION If CC 800131
EXPIRES: January 3,2003
9onded Thru Notary Public Underwritors
DIST. PERMITS
FLORIDA DEPARTMENT OF TRANSPORTATION
RE: Application for outdoor advertising sign permit
To be completed by applicant:
Name of Applicant or Company: MEDIANET, INC.
Sign is: existing X proposed
County: ST. LUCIE Municipality, if applicable
H' h N d N b r FLORIDA TURNPIKE
N/A
1g way ame an um e . S.R. 91
Sign location description: NORTH SIDE OF TURNPIKE 9 & 4/10 MILE NORTH � OF OKEECHOBEE RD.
ParcellD#: 1226-333-0002-000/4 i
To be completed by appropriate zoning official:
Designation of parcel on the Future Land Use Map:
Does this designation allow for commercial or industrial type uses, other than outdoor advertising, on the parcel?
Yes ✓ No /' III
Current Zoning of parcel (from Land Development Regulations): Vi - S
Does this designation allow for multiple primary uses on the parcel?
Yes No
FORM 575-070-04
RIGHT OF WAY
DOC - 11/99
PAGE 3of3
Does this designation allow for outdoor advertising on the parcel?
✓ Yes No
Does this designs on allow for commercial or industrial type uses, other than outdoor advertising, on the parcel?
Yes No
I certify that I am autr
'ed to sign this form on behalf of the county/municipality named above:
� lb •a o • oy
Sig ture of Local Government Official Date
Printed Name and Title
Local Government Permission: Please complete the items below. You may submit another form of written statement
indicating that the sign complies with all local governmental requirements. For a proposed sign location, la copy of the building
permit issued by the local government may be submitted.
The outdoor advertising sign identified in this application:
_ is in compliance with all duly adopted local ordinances and has been or will be issued the necessary permits.
is not in compliance with local ordinances, but is legally existing as a non -conforming sign.
_ is not in compli rice with local ordinances and is/would be considered to be an illegally maintained structure.
4-111 411��T /o- 23 -d-v
Signature of Local Go rnment bfficial Date
Pu 61"'- wo.- ks X r
Printed Name and Title
IiRECYCLED PAPER