HomeMy WebLinkAboutApplication for Outdoor Advertising PermitJ
FORM 575-07004
d� cO 2 O RIGHT OF WAY
� GC • 11r99
PAGE 1 OF 3
STATE O FLORIDA DEPARTMENT OF TRANSPORTATION
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: 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 . 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. FropeyrtT��at^� l't2f2 533I'1+;00`010
3. X Proposed Location FLORIDA
_ Existing sign: is located on: State Road #: 91 US Route #: N/A Local name & Number: TURNP I KE
7 & 8/10 Xmiles o feet NORTH of OKEECHOBEE ROAD , Sign will be/Is on the N side of the highway,
7WF97 j Nearest Intersection) (R:E.T.W.)
facing EAST 4. Distance of closest part of sign to edge of right of way: 25 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 LE AS lease site? If lease, name of landowner: OLC r INC.
7. Method of marking location: X Stake/flag 2L Painted pavement _Other(descdbe) SEE PHOTO
(C) SIGN DESCRIPTION:
1. Facing height: 10 1 — 6 11 Facing width: 3 6 t Total Sq.FI.: 3 7 8 2. Changeable facing? Yes X No
3. Height Above Ground Level: 461 4, Sign structure Height: 50 1 S. # of poles: 1
6. Material used for: Sion facing: METAL Supports. METAL
7. C g Back -to -Back _ Side -by -side _ Single faced
Qft`at 400 WATT HOLOPHANE FIXTURES ON CATWALK
g, I1I1 sign be lighted? Yes _ N If yes, describe lighting:
9. W ii cuttin8i45 trimzirrg of�)Mjation n Slate right of way be required to create a viewing zone for this sign? Yes X No
If the a swer is "Yes.' a Management Plan nustbe approved by the Department and the permits for two nonconforming signs cancelled.
Permit ag numbers to be cancelled: /A
10. Is a condition of Issuance of this permit other than for v
If yes, permit tag number to be cancelled: N/A
X No
NOTE: IF A PERMIT IS BEING CANCELLED FOR EITHER 15. OR 16., ABOVE, SUBMIT THE CAN ELLATION CERTIFICATION TOT E DISTRICT OFFICE
WITH THIS PERMIT APPLICATION. IF THE NEW APPLICATION IS NOT APPROVED, THE PERM (S) W@ENOTPE( i,-A7 f%ED.
REQUIRED ATTACHMENTS (Application will be returned as Incomplete if required attachments are iot submitted with the application- si Is instructions)
Landowner Aue+oh Wru X L=bcn sketch; XLocd Goverment zonirgla d use verification: X Locw Govertvrbnt bwWi g « of sito
V—X 9 marvXVs Per I9)6) end wnounduV vegetation: XApplication fee. PLEASE NOTE: If you do riot axrently hold an Outdoor Advi r�sitq 'r�ryay. � TTS
you to obtavt are before a pernin can be issued,
NOTARIZATION AND CERTIFICATION
I. L1tUV.LC,lu L . L:r1Ui4jAAby cen)fy 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 possession of the site to erect an outdoor advenising sign at the location designated in the application. I understand that submission or raise or misleading
information on this application, or any other violation of Chapter 479, Florida Statutes, or Chapter I4.10, F.A.C., may result in revocation of this permit. I further understand that the metal permit
tag must be postcd at the sign site within 30 days of suance and a completed sign as described in this application must be built within 270 days orpermit issuance or this permit is VOID.
f/ _ _ PRESIDENT
S aturc of applicant
Sworn and subscribed before me this day or
(Name or of?ri ). S/he,.i personally kno n to me c
Statc orl.�fi-(- r
Stgnaturc ay. ury. My Commission Expires:
Notary's Printed Name: ,••etit4� fig;-.KELLIE IVEY
EXPIHES: daritiary-3; 2003
%! o;Q '' Banded Thru Notary Public Underwriter:
FORM 575-07P8a
RIGHT OF WAY "" d
OGC • 11M
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: M DLA/ViS ODAIMS Application #: � � 7 d
12. Date/time reed by District:_ I —� % L�Cl By: P2R U K
13. Is application being submitted as result of a notice of violation? Yes No
If yes, Notice # and DOT Case #, if applicable: 9
14. Are existing permits being cancelled: _ Yes 4 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 #%f)z9 / I t:ti�/y f l KID_ Type highway: _Interstate FAP _k4._ Secondary (SHS)
16. Urban area? _ Yes ' 17. Incorporated? _ Yes 18. Within city? Yes
�c No �c No :z- No
19. Land Use: Zoned comm.Md. Unzoned oomm.find. _� Other AGo
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:.5 I LLL .l G— County number. 7 `f /
RCI Section: 9(/z17&Z20 Direction:—IM 21/Y Milepost: 72 . 76 7
Side of section: R 1 G-147— Sign read: LHR RHR Par
t N0 J2 i J%
RCI reference feature: ,( . 3 Distance from feature: /.ram !✓1�• Direction:
20, Inspector's name: Date location inspected:1o2 — J, Q
21. Distance from nearest permitted location (same side of highway):
SIGN INFORMATION r
Facing height:lj_ Facing width: .1 Structure height (above crown of road): Jr
HAGL: V Distance off RM: oZJ� r
Is sign being permitted as nonconforming: _9 Yes _ No
Pica � Ap o' e . Denied Intent to Permit (Veg.Mgmt.)
Signature of Inspector: Date:
Signature of ODA Administrator: Date: r 2 -
ventral Office approval:
For FDOTDistrict Use Only:
•
y^ �, �, a p 4,' ac
Posted? `;Yes Nc
Photo taken? =Y'es No
30-day posting date deadline:
* F^Notice
• _
Field checked on (Date):
�`
BY } 4k #
27Uay build date deadline:
Btnit7 Yes No
Photo taken: _ Yes _ No
Field checked on (Date):
s==
By , » 7- ;Notice #
For FDOT Central Office Use Only:
Date rec'd from District:: ),2-aa•0 O
C.ri— tt-
Certified Mail #: 700 D 0 (, 0 o M'�.1 /S' 0 9 6 a3L1
Structure #:
FORM $75-07004
-210 0 0 RIGHT OF WAY
/ `f O OGC • 11199
STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION PAGE 1 OF
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) 414.4645.
1. Name of Applicant or Company: MEDI ANET r 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 200 1
City/State/ZlpCode: MINNEOLAZ FLORIDA 34755
4. Mailing address for permit tag (If different from above): SAME AS ABOVE
(8) LOCATION INFORMATION:
i, County: ST. LUCIE � ProperiyT5.11` 22�51 3�31� 0i0.01� i00Q=/8.
3. X Proposed Location FLORIDA
_ Existing sign; Is located on; State Road M 9 1 US Route #: N/ Local name & Number: TURNPIKE
7 & 8/10 Xmiles a feet NOSH of OKEECHOBEE ROAD
. Sign will be/is on the N side of the highway,
facing
WEST Barest Intersection) (N.E. . .)
(N.E,S.W.)
4. Distance of closest part of sign to edge of right of way: 2 5 F E E T
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: i-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 r INC.
7. Method of marking location: X Stake/flag X Painted pavement —Other (describe) SEE PHOTO "
(CI SIGN DESCRIPTION:
1. Facing height: 10 1 — 6 11 Facing width: 3 6 1 Total Sq.Ft.: 378
3. Height Above Ground Level:
461 4. Sign structure Height: 501
6, Material used for: Sign facing: METAL Supports: METAL
7 c f X
Changeable facing? _ Yes X No
5. # of poles: 1
on tguratlon of sign. _ V-shape _ Back -to -Back _ Side -by -side _ Single faced
B. y �e�q� No Ifyes,describelighiing:400 WATT HOLOPHANE FIXTURES ON CATWALK
9,fa
l rr a talio on Stale right of way be required to create a viewing zone for this sign? _Yes X No
If thswer is 'Yes,r'�a Managg{e�m{�ent PI must be approved by the Department and the permits for two nonconforming signs cancelled.
Perg n4Vl A % a clfwlle kd: N/A
10, s an existing permit being cannccelled as a condition of Issuance of this permit other than for vegetation management? ,_ Yes x No
If yes perDf ISTN IVERWUtSlled: N/A
NOTE'iFS 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.
XREQUIRED ATTACHMENTS (Application will be returned as Incomplete If required attachments are not submitted with the application. see instructions)
-0.A1etv120b., Location Sketch; XLooal Goverrment zoninott rid Use VeriAcation, X Locei Govanvnent building p-rA Or equivalent X Photograph or site
"'o—g mar"s L— IBM and stxrourding vegetation: XAppfication fee. PLEASE NOTE: If you do npi Lt ity, hold an Outdoor Advertlsing LJCOM. it may be necessary for
ycu m obtan one before a pemvi inn be issued.
NOTARIZATION AND CERTIFICATION
1, 1Jtu 1 C L L. Ut1Ulr yy ocnify that the information given and the statements made in this application are true and that I have received, to writing, permission from the
landowner or 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 false or misleading
information on this application, or any other violation or Chapter 479. Florida Statutes, or Chapter I4•10, F.A.C., may result in revocation of this permit. I further undcntand that the metal pemil
tag must be posted at the sign site within 30 days 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.
PRESIDENT
SwLiurcofapplicant
Sworn and subscribed before me this day
INamc or arrunpq. S/he is personally known to m
'
State of I r F{ f (I CK j '
Signature
Printed
THI
My
KELLIE IVEY
''d, of n° •`' Bonded Thru Notary Public llnderwr4gra 15
STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION
APPLICATION FOR OUTDOOR ADVERTISING PERMIT
(THIS PAGE FOR DEPARTMENT OF TRANSPORTATION USE ONLY) �7
11. Applicant: AA lED1A/�%� / //y C ODAIMS Appli ion #: �� L
12. Dateltime rec'd by District: I I! - _7 - By: � 2Q.:4 1����1
13. Is application being submitted as result of a notice of violation? Yes V_ No
If yes, Notice # and DOT Case #, if applicable: !?!1 - 0Z/ S
14. Are existing permits being cancelled: _ Yes _�C. 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 #:;SiZ Cj / I CI ZV A K F Type highway: _ Interstate FAP Y Secondary (SHS)
16. Urban areal Yes 17. Incorporated? Yes 1B. Within city? � Yes
1K No � No :E No
19. Land Use; Zoned comm.find. Unzoned comm.Md. -y-_ OtherA& 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 T L(.LQ)
County number.
RCI Section: 9V y 7 aV62
Direction: %1 k # Milepost: DC 76 7
Side of section: _Q I /- W7—
Sign read: -,V- LHR RHR Par
RCI reference feature: - ! X 140,3
Distance from feature: d , 6:A iYA I Direction: -_/0 /2
20. Inspector's name:
- Date location inspected:_
21. Distance from nearest permitted location
(same side of highway): 1
SIGN INFORMATION
r d ' 9Q /
Facing height:_ Facing width: Structure height (above crown of road):
i
HAGL: `/�o
r
Distance off RM: �5
Is sign being permitted as nonconforming: )4f Yes _ No
-patianion �N1 Appro`ved Denied Intent to Permit (Veg.Mgmt.)
Signature of Inspector:
Date:
Signature of ODA Administrator:
�- Date:
Central Office approval:
Dater/3 7 400
For FDOT District Use Only:
z a
30-day posting date deadline:
sYNo Photo taken?
PotedV es Yes _ No
*-L 2,rswxi¢z ti4;5,,'P!
*ry
Field checked on (Date): z' * By, v Notice # '
270-day build date deadline:
�Bu7t? F ^Yes No Photoaaken: Yes No
Field checked on (Date):
_ _
X rBy . ' O .Ce.
For FDOT Central Office Use Only:
Date rec'd from District:: 1'A-a:L- D b
Facing M Structure #:
n I ' /
RedtNumber. �7'�9�i
�Date_entered_ODA-IMSS:_
Date tag Issued: ivy Ii3i7D Tag # issued: xIt CA
Certified Mail #: 900D 0t00 0 003l
1,S-Di 433 (,F
FORM 575-070-04
RIGHT OF WAY
OGC • I IM
PAGE 2 OF 3
I
�I
_By: o
FORM 575-070-04
RIGHT OF WAY
OGC - 11/99
PAGE 3 of 3
FLORIDA DEPARTMENT OF TRANSPORTATION
RE: Application for outdoor advertising sign permit
To be completed by applicant:
Name of Applicant or Company:_
Sign is: existing
County: ST . LUC I E
Highway Name and Number:
Sign location description:_
Parcel ID#:
MEDIANET, INC.
X proposed
Municipality, if applicable: N/A
FLORIDA TURNPIKE S.R.91
NORTH SIDE OF TURNPIKE 8 & 2/10 MILE NORTH OF OKEECHOBEE RD.
1225-331-0001-000/8
To be completed by appropriate zoning official:
Designation of parcel on the Future Land Use Map: �Cn
Does this designation allow for commercial or industrial type uses, other than outdoor advertising, on the parcel?
Yes _ZNo e/
Current Zoning of parcel (from Land Development Regulations): /�' ;
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 designs n allow for commercial or industrial type uses, other than outdoor advertising, on the parcel?
Yes VNo
I certify4h@t I am aut i d to sip this form on behalf of the county/municipality named above:
a'
Sig ure 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.
io- a 3 -0-0
Signature of Local overnm nt fficial Date
Pud 11'C L4.)dr AS bI I^
Printed Name and Title
RECYCLED PAPER