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HomeMy WebLinkAboutApplication for Outdoor Advertising PermitFORM 575-07004 `O O O O RIGHT OF WAY 1 i OGC • 11,E STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION PAGE 10F 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. 1. Name of Applicant or Company: MEDIANET 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 2001 City/Slate/zipCode: MINNEOLA, FLORIDA 34755 4. Mailing address for permit tag (If different from above): S AME AS ABOVE (B] LOCATION INFORMATION: 1. County: ST. LUCIE 2. Property TaxlD#: 133©-33'1=©OOi10}00/1 3. X Proposed Location 91 FLORIDA _ Existing sign: Is located on: State Road M US Route #: N/A Local name & Number; TURNPIKE 7 's` 4/10 Xmiles ❑ feet NORTH of OKEECHOBEE ROAD , Sign will bells on the N side of the highway, Nearest Intersecbon (1T rw—) facing EAST 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. NIB, 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 r INC. 7. Method of marking location: L Slake/flag X Painted pavement _Other(descdbe) SEE PHOTO ICJ SIGN DESCRIPTION: 1. Facing height: 10 1 — 6 r1 Facing width: 3 6 t Total Sq.Ft.: 3 7 8 3. Height Above Ground Level. 461 4. Sign structure Height: 50 t 6. Material used for: Sign facing: METAL Supports: METAL 2. Changeable facing? Yes X No 5. # of poles: 1 7, Coe igu g Back-lo-Back _ Side -by -side _ Single faced 8. Will sig b e No If yes, describe fighting: 400 WATT HOLOPHANE FIXTURES ON CATWALK g, Will cutting noIr((tt�rimm'nglpf vegetation on State right of way be required to create a viewing zone for this sign? Yes X No If the an war is -k`ds',Va �gt3f>it Pfan m ist be approved by the Department and the permits for two nonconforming signs cancelled. Permit ta numbers to be cancelled: /A 10. Is at, exI1UHA1nrn ailfM&9d as 6 condition of issuance of this permit other than for vegetation management? _ Yes __L No If yes, permit lag 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 Uvldq W AO-W=bM X Location skew; XLoca Government zminw and use veri0cewo X Local Government Wilding pemtit, or awye ent: X Photograph of site vvwetg mark ngs (per (5)6) and surrwsc ing vegetation: XApplication fee. PLEASE NOTE: Ityet, do not currently hold an Outdoor Advertising license, it maybe necessary for you to obtain ono bar= a permit can be issued. NOTARIZATION AND CERTIFICATION I, 1Jt UN.LGl.r 1j. t..XIU1.,rhWby 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 possession or the site to creel an outdoor advertising sign at the location designated in the application. I undefstsnd 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 resull in revocation of this permit. I further understand that the metal permit tag must be posted at the sign site within 70 days of issuance and t e completed sign as described in this application must be built within 210 days of permit issuance or this permit is VOID. PRESIDENT re of applicant _ 1 / Position in Company. irapp5cable ,. Sworn and subse 'bed before me this-7a—day of: -Z INsmc of alto Srhe iiss-py{rtrsonally kn wn}o me or hu pip Sou of 1 I Stgnuure cl�wotary..r IVau Notary's Printed Name:_ My Commission Expires: 7T (J( As Wntilication. KELLIE IVEY MY COMMISSION # CC 800131 FORM 575-070-04 RIGHT OF WAY OGC • t 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: %Vl DIAI /GT ! /VC- ODAIMS Appli tion # 70 r 12. Date/time rec'd by District: //" �.y —C�� By. C G 13. Is application being submitted as result of a notice of violation? Yes V No If yes, Notice # and DOT Case #, if applicable: -O .-I 14. Are existing permits being cancelled: _ Yes ?g- 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 #: �g% 9;UJP/!if- Type highway: _ Interstate FAP Secondary (SHS) n 16. Urban area? Yes 17. Incorporated? _ Yes 16. Within city? Yes No K No :2 No 19. Land Use: Zoned comm.find. Unzoned commfnd. Other /0— " S If unzoned, name of three businesses: 1. 2. 3• Distances of businesses from each other: 1-2 LOCATION INFORMATION 2-3 3-1 County name:,!T t u C , 15 County number. Vy J yv RCI Section: 9`t' Y W ()Q Direction: Milepost: Side of section: i2 I G-N 1Q Sign read: LHR RHR Par RCI reference featureUau- 4,A Distance from feature: L - 143 Direction: /vDRM o 20. Inspector's name: tAAK. -'y GN/-kAA - Date location inspected:f..7 — t-) "nQ 21. Distance from nearest permitted location (same side of highway): /Z %C "r SIGN INFORMATION Facing height: /jQ Facing width: Structure height (above crown of road):y HAGL: L/ iI`n / Distance off RIW: 0�5 Is sign being permitted as nonconforming: ___L6 Yes _ No Central Office approval: For FDOT District Use Only Intent to Permit (Veg.Mgmt.) Date: �� _ I Q —00 Date: �Z Z- 0 - 00 Date: z,L� 7 Zion) ti�.ac: x s y .r � 30 day posting date deadline:Py Sted3S�`=K Yes "'�(yoNY{ Photo taken? Yes No Field checked on (Date): 270-day build date deadline: 'Binh? t ( Yes _ No Photo taken: _ Yes _ No Field checked on (Date): :: « . By % .. X Notice #, For FDOT Central Office Use Only: Date rec'd from District:: ) as - O O Facing #: Structure #: Rec't Number. L9 3 9� Date entered ODA-IMS: I a 'a7- "_By- By: c—C Certified Mail #: ?COO 0600 OO Z7 15u 9 6 ;� 3 y .. - FORM 575470-04 RIGHT OF WAY () Q Lr OGc • 1 Im STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION PAGE 1 of J APPLICATION FOR OUTDOOR ADVERTISING PERMrr (A] APPLICANT INFORMATION: ` (If you currently hold a Slate 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: MEDI 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 . 0 • BOX 2 0 01 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 2. Property TaxiD'#�A®31� 3. X Proposed Location N/A FL0RID 91 A _ Existing sign: Is located on: State Road #: US Route #: Local name & Number: TURNPIKE 7 & 4/10 Xmiles o feet NORTH. -of OKEECHOBEE ROAD . Sign will bells on the N side of the highway, E Vfj .(Nearest IntersecUon (tom, -X) facing WEST 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 LE AS lease site? If lease, name of landowner: OLC r INC. 7. Method of marking location. I Slake/flag !Painted pavement _Other(describe) SEE PHOTO [C] SIGN DESCRIPTION: 1, Facing height: 10 1 — 611 Facing width: 3 6 1 Total Sq.FL: 3 7 8 2. Changeable facing? Yes X No 3. Height Above Ground Level: 46 1 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 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 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 I stma. eo aft eao19 it Fo p\ 10. Is an existing permit being cancelled as a condition of Issuance of thls permit other than for vege allon management? _ Yes _2L No If yes, permit lag number to be cancelled: N/A NOTE: IF A PERMIT IS BEING CANCELLED FOR EITHER 15. OR 16., ABO E, S MIT ANCE TION CE TIFICATION TO THE DISTRICT OFFICE WITH THIS PERMIT APPLICATION. IF THE NEW APPLICATION NOT APPROVED, DTHE 11PERMIT( WILL NO BLthe , (� REQUIRED ATTACHMENTS (Application will be returned as Incomplete 048�d I�t I E�not ubmiltedd th5ac to - see Sirt�llDns) X Uwdc, m A Tlvwuw% X L=ocn Skelt»: XLoeal GovmrvrrentZonrVA and use V tag p;ma or eativalenbX to vv--,g marwngs (pa iB)6) and smound'ug vegetation: XApplication fee, PLEASE NOTE: If you do not arrsntly told an Outdoor A.dverttsirg Ucarue, it be s(r�Ltl>n you to obtan one before a pennit can be issued. Lam! L[ lr n� (of NOTARIZATION AND CERTIFICATION If I.L. CUY 1 C,1J iJ . %—nyl./Irisaby certify that the information given and the sutements made in this application are true slid that I have received, int., sots rri'rTi FZR landowner or other person in IswNi possession or the site to erect an outdoor sdverisinS Sian 9 the location designated in the application. I understand that submission of false or mu e lamr— information on this application, or any other violation of Chapter 479, Florida Sututca. or Chapter 14.10, F.A.C., may result in revocation orthis permit. I further understand that the metal permit tag must be potted si the sign site within 30.days of issuance an the completed sign as described in this application must be built within 270 days of permit issuance or this permit is VOID. ��5� &� PRESIDENT �gnature of applicant I { Poshlon /tS� CogQ Y, if ap I. bt Sworn and subscribe before me this C day of y Q.�1 l 1 >'// `/ , c �� IN, of af6an c is peso IIY known io mror hu pr ced r as identirication. j%' J Sou of - i. (. 1 �%� ' � , Signature of :Vorfry._ \ yJ V,Q.� (�Jl �� My Commission Expires: Name: KELLIE IVEY UPON APPROVAL. THIS APPLICATION BFCOMFS TNF OPOMIT coo TUC E)CCC ou1-- . ,umded Thru Notary Public Underwriters r I. FORM 575-070-04 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) 7 0 2— 11. Applicant: /VI L �/�I1/1- / LL/Vf�i ODAIMSAppllcation,#: 12. Date/time rec'disj District: %%�� %'[7(� By:�7L 1 C,AAAA, 13. Is application being submitted as result of a notice of violation? Yes No If yes, Notice # and DOT Case #, if applicable: 11 O X /s 14. Are existing permits being cancelled: _ Yes No For vegetation management? Yes 1K No Current tag #(s): (If yes, applicant must submit Cancellation Certification to the District office with this permit application.) 15. State road #: ; R '1 ` r f 2 �U ���� Type highway: Interstate FAP Secondary (SHS) 16. Urban area? Yes 17. Incorporated? _ Yes 18. Within city? Yes No ,c No No 19. Land Use: Zoned comm./Ind. Unzoned commAnd. _ , Other ACr -J If unzoned, name of three businesses: 1. 2. 13. , Distances of businesses from each other: 1-2 2-3 3-1 LOCATION INFORMATION County name: 5o i k= U GJC_ County number. 7 -7 RCI Section: S? y y 7t)000 Direction: N Milepost: C� ? • 09 9 Side of section: ! I tom-1 1- Sign read: -X- LHR RHR Par RCI reference feature: 1 -Lb o' 60, 3 Distance from feature: t').163 /N j Direction: /Vd JRTl7 20. Inspector's name: - G Date location inspected: I `�/ - t)o 21. Distance from nearest permitted location (same side of highway): SIGN INFORMATION 1 , Facing height: IL) G Facing width: Structure height (above crown of road): 1 HAGL: y Distance off R/W: Is sign being permitted as nonconforming: Yes _ No Appltion '4?P d Denied Intent to Permit�,(Veg.Mgmt.) Signature of Inspector: Date: 1 �l q'V0 Date: � Signature of ODA Administrator: �'— 1 ! Central Office approval: Date: _R,77io.'% For FDOT District Use Only: '41, xr. 4 day date deadline: x Posted -Tauto Photo taken? Yes _ No 30 posting �h BY n Notice # ` Field checked on (Date): :- 270-da build:datedeadline: Btn1f? Y sx No Photo taken,_ Yes _ No Y. Field checked on (Date): '>_.r4'?=Notce.# For FDOT Central Office Use Only: Date rec'd from District:: 1�•�'�-00 Facing M _ Rec't Number. Certified Mail #: �OD 0 OL00 On I I SYo 1 6 a3q Structure#: Date entered ODA-IMS: oft FORM 575-070-04 RIGHT OF WAY OGC- 11/99 PAGE 3 of FLORIDA DEPARTMENT OF TRANSPORTATION RE: Application for outdoor advertising sign permit To be completed by applicant: Name of Applicant or Company: MED I ANET , INC. Sign is: existing X proposed County: ST . LUC I E Municipality, if applicable: N/A Highway Name and Number: FLORIDA TURNPIKE Sign location description: NORTH SIDE OF TURNPIKE 7 & 4/10 MILE NORTH OF OKEECHOBEE RD. Parcel ID#: 1330-331-0001-000/1 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 _ZNo Current Zoning of parcel (from Land Development Regulations): - S S.R. 91 Doess this designation allow for multiple primary uses on the parcel? V Yes No Does V this designation allow for outdoor advertising on the parcel? Yes No Does this designa on allow for commercial or industrial type uses, other than outdoor advertising, on the parcel? Yes V No I certify that I am authorized to sign this form on behalf of the county/municipality named above: A" a `� AD) -, •dam Site 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. 4% / 0/Z 310e Signature of Locakoverrinlent bfficial Date pub/, e- GlJr9rKs i ►^ Printed Name and Title RECYCLED PAPER 0