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HomeMy WebLinkAboutApplication for Outdoor Advertising Permit,,,✓✓✓ FORM 575-07044 0- 17C.F y �C.( RIGHT OF WAY OGC • I IM STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION PAGE 1 OF 3 APPLICATION 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: MEDIANET r INC. 2. FOOT Account Number. VF533468951001 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: t. County: S T. LUC I E 2 IPbioperty'Taz'IO#' -WIT2 r5r�3 3p1w 0�Oj 2— 0 ©©1� 5' 3. X Proposed Location FLORIDA _ Existing sign: is located on: State Road #: 91 US Route #: N/A 8 & 6 Local name r3 Number: TURNPIKE /10 Xmiles o feet NORTH of OKEECHOBEE ROAD , Sign will bells on the N side of the highway, eared ntersec on racing EAST FET--W) (N.E.S.W.) a. 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 N/A Distances of businesses from each other: 1-2 2-3 N/A 5. Doyou ownor LEASE 3.1 N/A lease site? If lease, name of landowner: OLC , INC . 7. Method of marking location: X Slake/flag !Painted pavement —Other (describe) SEE PHOTO (Cl SIGN DESCRIPTION: 1. Facing height: 1 0 1 — 611 Facing width: 3 6 1 Total S Ft.: 3 7 8 1 q 2. Changeable facing? ,_,_ Yes X No 3. Height Above Ground Level: 46 4. Sign structure Height: 501 METAL g 5. # of poles: Supports: METAL 1 6. Material used for: Sign facing: - 7. Configuration of sign: X V-shape _Back -to -Back ___,Side -by -side _Single faced 8. Will sign be lighted? XYes _ No If yes, describe lighting: 400 WATT HOLOPHANE FIXTURES ON CATWALK 9. Will cutting or trimming of vegetation on Stale 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 t Permit tag numbers to be cancelled: _ N/A nonconforming signs cancelled. 10. Is an existing permit being cancelled as a condition of issL ance of this permlt other than for v getatlon management? _ Yes X No If yes, permit tag number to be cancelled: N/A NOTE: IF A PERMIT IS BEING CANCELLED FOR EITHER 15. R 18., WITH THIS ABOVE, SUBMIT THE CAN ELLATION CERTIFICATION TO THE DISTRICT OFFICE S PERMIT APPLICATION. IF THE NEW APPLICATI N IS NOT APPROVED, THE PERMI (S) WILL NOT BE CANCELLED. REQUIRED ATTACHMENTS (Application will be returned as Inc �' nrAutr,oratior>: p L t)m Sk.I.N x,.oe�l r,Y,�ri12 v t submitted with the application- see instructions) s+� ry n 9s (Pa lal6) trr,o surrourq rq Ve(19181L �nDtiand use venficanorL' X 1-ocal Govarrvneru buUN pemvt or equivalent: X Photograph or alto XAPPScat on lea. PLEASE NOTE: g you do rot txlrrBnpy hold an Outdoor Advtut s rt0 License, d may be rtnoessary dbr Ya b rro Ore before a ) en can ou L&stjocttokV . NOTARIZATION AND CERTIFICATION I, W N.L GL L . l: tiU •�}bby eenify that the information given and the statements made in this application us true and that I have received, in writing, permission from the hndowrcr or other person in lawful possession of the site to erect an Outdoor advertising sign at the location designated in the application. 1 understand that submission of false or misleading the information on this application, or any other violation of Chapter 479, Florida Statutes, or Chapter 14-10, F.A.C., may result in «vocation of this permit. I further understand that the metal permit ua muA lX ste0 at tM sign site within 70 days ofissuance and the completed sign u describe in this application must be built within 270 days ofpermia issuance or this permit is VOID. / Y PRESIDENT gnatu« orapplicant Q Paition in Comp -arse}, If apfp�licable Sworn and subscribed before me this�day or ,I' f (1j,/�f n y theme of aRant). S1Te is personally known to me or has produced �/ By ,10 • ;r-s f u identification. State of Ji�C_CiJ CL Signature fN ry: L� �_Z.k��.tTC 5�i;'+,.'i%;•• KELUEIVEY My Commission trdj.' . r Notary's Printed Name:%i?;t .: MY COMMISSION S CC 800131 o EXPIRES: January 3, 2003 TI FORM 575-070-04 RIGHT OF WAY OGC • r v99 PAGE 2 OF 3 STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION APPLICATION FOR OUTDOOR ADVERTISING PERMIT (THIS PAGE FOR DEPARTMENT OF TRANSPORTATION USE ONLY) 11, Applicant: /A�%yN� I /,Yyc., ODAIMS Appli on #: ;� Z 7 a L"y 12, Date/time rec'd by District• I t `r % -06 By: tAA1V\ - 13. Is application being submitted as result of a notice of violation? Yes No If yes, Notice # and DOT Case #, if applicable: — O A+ S 14. Are existing permits being cancelled: _ Yes _K 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 #: -5R �1ry F (�&VP) t Type highway: Interstate FAP -J*—< Secondary (SHS) 16. Urban area? Yes 17. Incorporated? Yes 18. Within city? Yes -` No No :2 No 19. Land Use: Zoned comm.And. Unzoned commind. —,K- Other / G'% 5 If unzoned, name of three businesses: 1. 2. 3• Distances of businesses from each other: 1-2 2-3 3-1 LOCATION INFORMATION County name: �T �L,L�/�L� County number. 1 Q q 1 RCI Section: 9't'^ q 7O(.�(,(1 Direction: %V R �� �T Milepost: 3 • �i y Side of section: K. 1 64 7! Sign read: LHR RHR Par RCI reference feature: Y Distance from feature: A SRC M ) Direction: Alc�y. rd 20, Inspector's name: C Date location inspected: r�� L,it 21. Distance from nearest permitted location (same side of highway): 16(96 '� / - SIGN INFORMATION Facing height: ,10' / ` Facing width: y Structure height (above crown of road): HAGL: 1-i 61 r Distance off R/W: 1')-1-5 Is sign being permitted as nonconforming: Yes _ No ApPlieation Approved Denied Intent to Permit (Veg.Mgmt.) `Signature of Inspector: Date:_ Signature of ODA Administrator: Date: f Z -Zy Cad Central Office approval: Date: 11?7 e� For FOOT District Use Only: y< 30-day posting date deadline: a�YosteYeso�x Photo taken? _Yes _ No u Field checked on (Date): a Al n yh Notice # =' 270-day build date deadline: as . _ No' Photo taken: _ Yes _ No Field checked on. (Date): °tBy - X Notice#: For FOOT Central Office Use Only: Date rec'd from District:: )a. aA -06 Facing #: Structure #: Rec't Number. o _ Date enterer Certified Mail #: [ DOD bL O0 D02% %OS L 23-7 /- / (0 WE lv FORM575-07044 RIGHT OF WAY ;to 00 — �{ - �� S OGC.11M STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION PAGE 1 OF' APPUCA71ON 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 file 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: MEDIANET y INC. 2. FDOT 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: tall �tl, 1. County: S T . LU,C I E 2.1ropeTax ID�a'IY2�5r�`3►31"10 0 0 2b10f 100�/5l? 3. X Proposed Location FLORIDA _ Existing sign: Is located on: State Road M g 1 US Route M N/A Local name & Number: TURNPIKE 8 & 6/10 Xmiles o feel NORTH or OKEECHOBEE ROAD . Sign will bells on the N side of the highway, WEST TN 77 (Nearest ntersecton) FTMV,) 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: I Stake/flag !Painted pavement —Other (describe) SEE PHOTO (C) SIGN DESCRIPTION: 1. Facing height: 10 1 — 6 11 Facing width: 3 6 1 Total Sq.FI.: 3 7 8 2. Changeable facing? _ Yes X No 3. Height Above Ground Level. 461 4. Sign structure Height: 50 1 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 -side _Single faced B. Will sign be lighted? XYes _No If yes, describe lighting: 400 WATT HOLOPHANE FIXTURES ON CATWALK 9. Will cutting or trimming of vegetation on State 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 Issue ice V% Vol;ation management? _ Yes X No If yes• permit tag number to be cancelled: N/A mffi..+Y a1 aetw — NOTE: IF A PERMIT IS BEING CANCELLED FOR EITHER 15, 0 16.,A�Q��y B�1 IT�'�y�ANC LLATION CERTIFICATION TO THE DISTRICT OFFICE WITH THIS PERMIT APPLICATION. IF THE NEW APPLICATIO IS N07Y4BF7R EB, YF� I RMIT ) WILL NOT BE CANCELLED. REQUIRED ATTACHMENTS (Application will be returned as Inco X La 00 net Auenri ltoe%; X Location si ewh; XLocat Goverrvnam ZonirVLww use snowetg marvings (per i8A) and surrounding vegetation: XAppGeation bee• PLEASE N yo,, to ocu n one before a poirmi can be issuod. NOTARIZATION AND CERTIFICATION attachments are noll submitted with the application• see instructions) L equivalent X Photograph or site License. 4 may be necessary b r I. DANI EL L . CHO11411 certify that the information given and the statements made in this application are true and that I have received. In writing, permission from the landowner or other person in lawful posscasion orthe site to creel an outdoor advertising sign at the location designated in the application. 1 understand that submission or 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 lay must be posted at the sign site within 30 days of issuance and th omplcted sign as described in this application mutt be built within 270 days of permit issuance of this permit is VOID. PRESIDENT 5 attire of applicant %�• L �. Position In Company, if applicable Sworn and subterilxd be tort me this 1 day of _ l l� S -1 g02 INamc of afntnq. S/he is personally known to me or has produced _\4 f q u identification. — — — —_— — State or— fr--(-XA C KELLIE IVEY .°: MY COMMISSION # CC 800131 St nature of Non s' g ry ) My Commission Expires: y}} E _ EXPIRES: January 3, 2003 Notary's Printed Nameit '%? ::�?�' Bonded Thru Notary Public Undarwdtars FORM 575470-04 RIGHT OF WAY OGC • I IM PAGE 2 OF 3 STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION APPLICATION FOR OUTDOOR ADVERTISING PERMIT (THIS PAGE FOR DEPARTMENT OF TRANSPORTATION /USE ONLY) / � 11, Applicant: AA �-- �/�l/1% /�% /r / V � ODAIMS Appli tion #: 12. Date/time rec'd by District: i `` -00 BY 13. Is application being submitted as result of a notice of violation? Yes I>-- No If yes, Notice # and DOT Case #, if applicable: !qq - a X Is,— 14. Are existing permits being cancelled: _ Yes Z No For vegetation management? _ Yes No Current tag #(s): (If yes, applicantmustsubmit Cancellation Certification to the District office with this permit application.) 15. State road #: S /� W % 1 (.p 20 701 F Type highway: Interstate FAP --K Secondary (SHS) 16. Urban area? Yes 17. Incorporated? � es 18. Within city? � Yes �` KCCNo 19. Land Use: Zoned command. Unzoned command. Other /r-7 -J If unzoned, name of three businesses: 1. 2. 3. Distances of businesses from each other: 1-2 2-3 3-1 LOCATION INFORMATION County name: ,<;; 1 L (J C-IIL',�1 County number: y 9 !� r I r' RCI Section: 9 y g 7 e [./t.) Direction: NORM Milepost: a 3: 'I 9 'f Side of section: KI Gia 1 Sign read: ,L LHR RHR Par RCI reference feature: Nk / Distance from feature: r •S W\ 1 Direction: 1\16R r/Y Vv- 20. Inspector's name: _ Date location Inspected: icy.-% 21. Distance from nearest permitted location (same side of highway): �' r SIGN INFORMATION Facing height: lS:1-,C_ Facing width: Structure height (above crown of road): SV HAGL: q%- / Distance off RM: eQ 151 Is sign being permitted as nonconforming: I(- Yes _ No Signature of Inspector: Signature of ODA Adm Central Office approva For FDOT District Use Only: Intent to Permit (Veg.Mgmt.) Date: �. D - i - Date: /Z- zU Date: 30 day posting date deadline:. M'x aPostec�=Yes too r Phofo taken?, Yes _ No �.S a' .}y X Cy':,i.� LtM ��N.C.V f•Y ✓ ,`Xlry„N Field checked on (Date): 270 day build date deadline: �' �Bu1t? �� "esn No sr Photo taken: _ Yes No 777 Field checked on (Date): s= B.y For FDOT Central Office Use Only: Date reed from District:'.' ` () b Facing #: n I I Structure #: Rec't Number tog5q-9—bate-entered-ODA--IMS: ) a' % ` B EOZ tag •s�q- IoZ�.oZ�% �► Tiag #issued W%�i O Certified Mail #: 200 Ot, 00 60 a1 1�y / :i, *'. M X FORM 575-070-04 RIGHT OF WAY OGC- I1/99 PAGE 3of3 FLORIDA DEPARTMENT OF TRANSPORTATION RE: Application for outdoor advertising sign permit To be completed by applicant:. Name of Applicant or Company: MEDI ANET, INC. Sign is: existing X proposed County: ST . LUCIE Municipality, if applicable: N/A Highway Name and Number: FLORIDA TURNPIKE S.R. 91 Sign location description: NORTH SIDE OF TURNPIKE 8 0/10 MILE NORTH OF OKEECHOBEE RD. Parcel1D#: 1225-331-0002-000/5 To be completed by appropriate zoning official: Designation of parcel on the Future Land Use Map: dC - 5 Does this designation allow for commercial or industrial type uses, other than outdoor advertising, on the parcel? Yes V' No Current Zoning of parcel (from Land Development Regulations): Iva - S Does this designation allow for multiple primary uses on the parcel? ✓ Yes No Does this designation allow for outdoor advertising on the parcel? ✓ Yes No Does this design tion allow for commercial or industrial type uses, other than outdoor advertising, on the parcel? Yesyp No I certify that I am authorized to sign this form on behalf of the county/municipality named above: aO-moo 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, a 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 compliance with local ordinances and is/would be considered to be an illegally maintained structure. Signature of Local UT ernme O ial Pk b kc- L'od'- Ks Printed Name and Title /d - A 3-C.-Le Date RECYCLED PAPER 0