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HomeMy WebLinkAboutApplication for Outdoor Advertising PermitFORM 575-07404 20 0 0 _ g y _ RIGHT OF WAY Y OGC • 111M STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION PAGE I 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 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. i. Name of Applicant or Company: MEDI ANET, INC. 2. FDOT Account Number. VF593468951001 It 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 2 O 0 1 City/$late/zipCode: MINNEOLA FLORIDA 34755 4. Mailing address for permit tag (if different from above): SAME AS ABOVE (B) LOCATION INFORMATION: 1. County: ST. LUCIE 122�5 31�311+ + _ b. ro Pperty Tax ID#: O10 FRV- '.0008,. 3. ' X Proposed Location 91 FLORIDA _ Existing sign: Is located on: State Road #: US Route #: N/A Local name &Number: TURNPIKE 8 & 2/1 O Xmiles a feet NORTH of OKEECHOBEE ROAD Si n will be/Is on the N ��M Nearest intersection) g side of the highway, EAST (Wn-. W•) facing 4. Distance of closest part of sign to edge of right of way: 2 5 FEET (N. E.S.W.) 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 LEASE lease site? If lease, name of landowner: OLC , INC, 7. Method of marking location: X Slake/flag X Painted pavement —Other (describe) SEE PHOTO [C) SIGN DESCRIPTION: 1. Facing height: 10 ' — 6 11 Facing width: 3 6 Total Sq.Ft.: 378 2. Changeable facing?_ Yes X No 3. Height Above Ground Level: ' 6 a. Sign structure Height: 5 0 ' S. # or 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 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 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 condi }v ��hen for vegetation management? __ Yes X No If yes, permit tag number to be cancelled: N/A -m A \.1 �p 7 I NOTE: IF A PERMIT IS BEING CANCELLED FOR El WITH THIS PERMIT APPLICATION. IF THE NEW A REQUIRED ATTACHMENTS (Application will be recur p Larowvny k4honl-bon; x Locatbn Siulm XLO d Govemnertl y+� nury (Der INS) and surrourdrp vegetation; XAPplication you to oomr re oetare a pamil Can be Issued NOTARIZATION AND CERTIFICATION IER 15. OR 16., ABOVE, SUBMIT LICAN"SNCYTMTED,7 I as Incomplele if required altachr W-W4Use ver kallon: X Local Govemmen Pa�MwlRiametkhold al HE CANCELLATION CERTIFICATION TO THE DISTRICT OFFICE E PERMIT(S) WILL NOT BE CANCELLED. ienls are not submitted with the application• see instructions) 7u1dirni permit. or equivalent X Photograph or site Outdoor Adv ISN License, it truly to necessary for i, LJHIV 1 C,L Lr . L;HU dtj)fby certify that the information given and the statements made in this application are true and that I have received, in wrilin , landownn x other person in lawful possession of the site to erect an outdoor advertising sign at the location designated in the application. I understand that submission of! Ise or misleading in formation m this application, or any other violation of Chapter 479. Florida Statutes, or Chapter 14.10. F,A.C,,. may result in revocation of this permit. I funher understand that the metal permit tag mum be posted at the sign site within 30 days of issuance and t e completed sign as described in this application must be built within 270 days orpormit issuance.or this permit is VOID. PRESIDENT 511trts--•- .. Sworn (Name State or Signaru s %r-inCa: January 7 9Ma FORM 575-070-04 RIGHT OF WAY OGC • I lm 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: l /►A f- ' 4ALV h • - / /�% ODAIMS Application #: _� r 12. Date/time reed by District: �� 7 - By �fiQ2y �, ��I AWN, 13• Is application tieing submitted as result of a notice of violation? Yes /, No If yes, Notice # and DOT Case #, if applicable: 9 9 - C9 'Z/.Cl� 14. Are existing permits being cancelled: _ Yes � No For vegetation management? _Yes k No Current tag #(s): (If yes, applicant must submit Cancellation Certification to the District office with this permit application.) 15. State road #: 5 R Qj ,7'(J ZVp! xF -- Type highway: _Interstate —FAP _X_ Secondary (SHS) 16. Urban area? Yes 17.. Incorporated? � es 18. Within city? - YNoes 19. Land Use: Zoned comm.Md. Unzoned commind. --K- Other A t-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: S LU C j L= - County number. y 4 RCI Section: 9yU 7BC ) Direction: / i Milepost: �� • ��� Side of section: f�l C" t7 'f Sign read: LHR � RHR Par RCI reference feature: , y Distan e from feature: 1 Direction: 1y0 ;z.rfi 20. Inspector's name: l Date location Inspected: 21. Distance from nearest permitted location (same side of highway): SIGN INFORMATION Facing height: l '_ Facing width: Structure height (abovecrownof road): r�C% HAGL: L/c`` 0 / Distance off WIN: dam✓ Is sign being permitted as nonconforming: -% Yes _ No For FDOT Central Office Use Only: Date rec'd from District:: fA `otaxrb Intent to Permit (Veg.Mgmt.) Date: - 1 a -Q 6 Date: / 'L. - 2 C1 - C21 e., ;. 4#• Structure #: Certified Mail #: tbo D& oo on,;L7 IS090-34 — f - 61 0 17'i FORM 575 C70.04 9� - 7 R1GNT OF WAY ?i 0 0 (7 ` OGC • 1 L99 STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION PAGE I OF 0 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 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: MED I 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 a 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: I. County: ST. LUCIE 1225-331 Q©101w. (. r . //_z 2ProRerty Tax_ ,'s % IQ O 0. /:8 3. X Proposed Location 91 FLORIDA _ Existing sign: Is located on: State Road #; US Route #: N/A 8 & 2 Local name & Number; TURNPIKE /10 Xmiles o feet NORTH of OKEECHOBEE ROAD Sign will be/is on the N E• •W Nearest ntersecton side of the highway, facing WEST IN.(fT•�•I (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 N/A 3. N/N/A Distances of businesses from each other: 1-2 2-3 A 6. Do you own or 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 [C] SIGN DESCRIPTION: 1. Facing height: 10 t — 6 It Facing width: 3 6 I Total Sq.Ft.: 3 7 8 I 2. Changeable facing? _Yes X No 3. Height Above Ground Level: 46 4. Sign structure Height: 50 f METAL g 5. # of poles: 1 6. Material used for: Sign facing: Supports: METAL 7. Configuration of sign: X V-shape _ Back -to -Back _ Side -by -side _ Single faced 8. Will sign be lighted? ?CYes _ 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 view' his sign? If the answer is _ Yes X No 'Yes,' a Management Plan must be approved by the Dep Permit tag numbers to be cancelled: N/A MERIEWo�two onconforming signs cancelled. 10. Is an existing permit being cancelled as a condition of Issuanc of thisN00 6F2 lh2QHvegel Ion management? _. Yes X No If yes, permit tag number to be cancelled: N/A NOTE: IF A PERMIT IS BEING CANCELLED FOR EITHER 15. OR 1 WITH THIS PERMIT APPLICATION. IF THE NEW APPLICATION IS TION CERTIFICATION TO THE DISTRICT OFFICE VILL NOT BE CANCELLED. XREQUIRED ATTACHMENTS (Application will be returned as Incomplete if required attachments are not submitted with the application- see instructions) Larnowrter PurPnrizab- X Lac - Skalds Local Ocvermmnt Zori _ t9 markirtps (per Isis) and surround nD'tOM Ufa Verification; X Local Government buildin0 panne, or egtival-I, r of she 80 you W o0tain Oro DOldrO a '^O vegalalion; XAPP15=50n fee. PLEASE NOTE: If you do not ourniney hold an OUW=/(C,,arising License, R may be necessary for pwint Can be issued, NOTARIZATION AND CERTIFICATION 1. LHIV 161j L.I. L; UU •4%Aby certify that the information given and the statements made in this application are true and that I have received, in writing. landowner or Other person in lawful possession or the site to erect an outdoor advertising sign at the location designated in the application. I understand that submission ofb fale or misleading rnformauon on this application, or any other violation of Chapter 479. Florida Statutes, or Chapter 14.10. F.A.C., ma tag must be posted at the sign site within JO days of issuanre and a Completed sign ss described y ruuh in revocuion of this permit. 1 further undersund this the maul perms lication must be built within 270 days of permil issuance or this permit is VOID. "p � 'f in this app /Signawre of Applicant PRESIDENT Swom and subscribed before me this �� day of (Name of atrtant) S/he is personally known to me or his produced State of �1; ,,IQz , > -, Signature of Printed tir+rry,, KEWEIVEY My Commission Expires: oa: MY COMMISSION # CC 800131 EXPIRES: January 3, 2003 Bonded ThruNo" publicUnderwriters FORM575470-04 RIGHT OF WAY OGc • 11199 PAGE 2 OF 3 STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION APPLICATION FOR OUTDOOR ADVERTISING PERMIT (THIS PAGE FOR DEPARTMENT OF TRANSPORTATION USE ONLY) D 11. Applicant: i I ODAIMS Appii tion #: 12. Dateltime rec'd by District: I I —oZ7-06'gy; }1i2i� 13. Is application being submitted as result of a notice of violation? Yes k No If yes, Notice # and DOT Case #, if applicable: 12 — r7 14. Are existing permits being cancelled: _ Yes � No For vegetation management? _Yes No Current tag #(s): Cancellation/Certification to the District office with this permit application.) (If yes, applicant must submit 15. State road #: AK �� I (��/!r PI I<�= Type highway: Interstate FAP -9— Secondary (SHS) m 16. Urban area? Yes 17. Incorporated? _ Yes 1S. Within city? Yes No X No =I No CC ig. Land Use: Zoned comm.Md. Unzoned commAnd. _ Other,46-5 If unzoned, name of three businesses: 1. 2. 3. Distances of businesses from each other: 1-2 2-3 3-1 n j LOCATION INFORMATION ) County name: - T U �'_. (� County number. 9 00 9 c l O% 7 d 60 Direction: 1�[�? !� jMilepost: 3. I;9 t< RCI Section: - a. Sign read: _ LHR RHR Par Side of section: _ W R AA Direction: /yoR 1 �� RCI reference feature: Distance from feature: Y ^ o 20. Inspector's name: � " Date location inspected:-4— V focation 21. Distance from nearest permitted (same side of highway): SIGN INFORMATIONol Facing height: 6 Facing width: ��� Structure height (above crown of road): , HAGL:\, `7 v Distance off RM: _ (Q !J Is sign being permitted as nonconforming: Yes _ No �Ap Rcatin ApproveDenied Intent to Permit (Veg.Mgmt.) Date: `"� Signature of Inspector: Date: �O - CM Signature of ODA Administrator: Central Office approval: Dater For FDOT District Use Only: Avz •. Poste es o hototaken? s Yes _ No, 30-day posting date deadline x 'r� �� Ce x} oU # By.�. Field checked on (Date): • u ��,�� x'Ni.v. ..Kf IYSrJ•. , a i Y h 270�ay build date deadline: P otG taken:_Yes _ No .y Field checked on (Date): <B �>> tJopce# For FDOT Central Office Use Only: Date rec'd from District:: 1 a- a� oZ - lD D Facing #: Structure #: E5--16 nh,.. k— /9.2ef -Data-entered ODA-IMS: /a �a 1 • By: Certified Mail #: 2ono W.00 D 6a7 /Sol 693 L/�_ 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: b FLORIDA TURNPIKE N/A S.R. 91 FORM 575-070-04 RIGHT OF WAY OGC - 11/99 PAGE 3of3 Highway Name and Num er. Sign location description: NORTH SIDE OF TURNPIKE 7 & 8/10 MILE NORTH OF OKEECHOBEE RD. ParcelID#: 1225-331-0001-000/8 To be completed by appropriate zoning official: Designation of parcel on the Future Land Use Map: A; - Jt 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): 146 " 5 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 designation allow for commercial or industrial type uses, other than outdoor advertising, on the parcel? Yes _Z No I certify that I am au onzed to sign this form on behalf of the county/municipality named above: 129- 26 -00 tu_re 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 Government Official Printed Name and Title Date RECYCLED PAPER 0