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HomeMy WebLinkAboutApplication to Connect to, or Use, District Facilities, or for Utility ConstructionDistrict Use Only: No. - - ELK— - —J— FORT PIERCE FARMS WATER CONTROL, DISTRICT ("District") 14666 Orange Avenue - Fort Pierce, Florida 34945 - (772) 461-5050 - FAX (772) 461-9446 A®olication to Connect to. or Use, District Facilities. or for Utility Construction* A. General Information: Applicant Information: Owner Information (if different from Applicant): Name: - &J i f Co Ac t" t C: Name: Address: V9 1? VV\ A, o Address: Telephone: (,'11 Z) S`( - (Ilk C —L Email: G)Q(c.t cL . <�t S AQ f�.a-t4 - t , ( c.t,t Enaineer of Record Information (if applicable): Name: Address: Telephone: ( ) Telephone: l ) Email: Billina Contact Information: Name: 'A D-A�< C1ASCtG Address: " � `ICS 12. kt\ SO Telephone: (`irjZ) a55 `I - rlt(.O Email: CAdcu ` B. Project Information: (Check appropriate box and attach drawings to show location and details): ❑ Culvert Connection to District canal for irrigation or gravity drainage. ❑ Pump Connection to District canal for irrigation or drainage. ❑ Installation of culvert or water control structure in District canal for crossing or water control. ❑ Utility Crossing: , ❑ Electric ❑ Telephone ❑ Gas ❑ Cable'relevision ❑ Water Main ❑ Force Main 13--� , -'41l • t"trDl -eta ❑ Other (specify): &gg � c Ci at Q r ,c e.t,5 A c 2t'c?cat " `f AA,,- - 1 cA _ Location: Section(s): 09 Township: 34S Range: _ Description of Indirect Connection: Drainage area served: acres (Culvert or pump Connections.) C. Construction Schedule: Estimated commencement date: 3"! & Estimated completion date: D. Application, Use Fee: S � • & Review Deposit: $ (Submit fee with this application in accordance with the District's fee schedule.) Canal No.: ACKNOWLEDGEMENT AND ACCEPTANCE: As reflected by my signature below, I hereby certify that the information shown above is accurate to the best of my knowledge, and that I agree to satisfy or abide by all requirements of this Permit, including "Standard Provisions" itemized on the reverse, and "Special Conditions" imposed by the District. Further, I acknowledge that the District and its Engineers are doing work to benefit the property and non-payment may result in filing of a construction lien as permitted by the Florida Statutes. Owner Signature: , 4dci / L1'tff Owner Name (Type or Print): Date: 01-10 - 2o�0 (I of 3) Distract Use Only: No. - - - --L- FORT PIERCE FARMS WATER CONTROL DISTRICT ("District') 14666 Orange Avenue • Fort Pierce, Florida 34945 • (772) 461-5050 • FAX (772) 461-9446 Application to Connect to. or UQe. District Facilitie& or for Utility Construction* SPECIAL CONDITIONS: (for District Use Only): rssssss»ssss»s»r»rr»sr»ssssrrrsssssrssrsrrrrrrs»rsssssssr»rrrsssssrrsrr»ssrsssssssss»rs»rsssrsrrrssss»rsssrsrs Application Approved and Permit for Construction Issued: Water Control District Permit Expiration Expiration Date: ssrsrrssrrssrsrsrsrsssssssssrsssrs»sssssrs�ssrrssrssrsssssssrsssss»rss»sssssssrsss»rssssss»s»srsrasssssrsessrr Project Certification Received and Accepted: By: Date of Approval: For the Fort Pierce Farts Water Control District Certification Expiration Date: W1/t rr»trrrrr r*�� �fteQ ``arrsss1, STANDARD PROVISIONS for Application / Permit No. Oaf Q If this Application for a Permit is approved, I do aclmowledge, understand, and agree that: 1. I hereby indemnify and hold the District harmless from claims for property damage or personal injury arising from the installation or use of the permitted facility, and that this indemnification extends to damage to the facility itself that may occur from District operation and maintenance work 2. Approval of this application does not relieve the Permittee from securing any and all other permits that may be required by other entities or governmental agencies, including, but not limited to, the South Florida Water Management District, the Florida Department of Environmental Protection, and St. Lucie County. 3. The use ot; or construction within, the District's right-of-way shall conform to the details of the attached approved drawings supporting this application. Modifications must be approved by the District in writing prior to construction. 4. If required in the interests of the District's operation and maintenance program, or by any modifications to the District's Standard Provisions, I agree to alter, replace, relocate, or remove the permitted facilities at no cost to the District, all as is more fully set forth by District Policy Resolution duly recorded in O.R. Book 673 at page 224 of the Public Records of St. Lucie County, Florida, but subject to the limitations thereof. 5. The lands to be benefited by this application are, or may be, subject to flooding during periods of high water resulting from heavy rains or other acts of God. This Permit will be accepted subject to this possibility, which is recognized not to be within the control of the District. 6. Any other requirements that may be imposed by the District are binding upon me, my successors and assigns. 7. Any Permit issued as an approval of this application other than one issued in irrevocable, recordable form pursuant to the Policy Resolution referenced in item 4, above, shall not be transferable fiom the Permittee to a subsequent owner or owners of all, or a portion o& the subject property without the express, written approval of the District. 8. Any Permit issued as approval of this application is strictly subject to all of the rules of the District, duly promulgated from time to time, which are on file and available for examination at the offices of the District by those having interest 9. If a Permit is granted, I shall notify the District not less than 24 hours prior to the beginning and completion of the work, to enable the coordination and scheduling of inspections. 10. I accept total responsibility for any erosion o& or shoaling in, the Districts right -of --way or canals that results from the permitted work, and I shall repair or remove same promptly, at no expense to the District. 11. During and after construction, I shall prevent material from the construction area from being discharged to, or settling in, District canals. 12. Unless authorized by Permit, I shall neither place, construct or plant, nor cause to be placed, constructed or planted, any object or improvement within the District right-of-way without the express written prior approval of the District. 13. Within thirty (30) days of completion of the work, I shall submit a written statement to the District certifying that the worst was performed and completed in accordance with the Permit and the approved drawings. If the work deviates from the Permit or approved drawings, the certification shall state the nature and extent of those deviations. 14. If this Permit is for a drainage connection, then drainage discharge from the area served shall not exceed the volumetric equivalent of 2.6 inches of depth over the area for any 24-hour period (50 gallons per minute per acre) Stun the 10-year fiequency, 72-hour duration rainfall. 15. If a Permit is issued for a hydraulic connection of property with a District canal, I shall not discharge hyacinths or other aquatic vegetation into the District canal. 16. The Permittee, his agents and contractors, shall conduct the worts in a manner that will not impair the use, or potential use, of the District right-of-way and fircilities. In no case shall drainage or irrigation canals or appurtenant works be obstructed or restricted. 17. All irrigation and drainage connections to District facilities shall be clearly marked with a post of contrasting colors to identify the location and extent of the permitted installation. 18. If access is permitted via an existing culvert crossing installed in District right-of-way, the Permittee is advised that the crossing may be permitted for use by other affected owners, as such crossings are limited in number by the District. 19. The District reserves the right to permit the use of culvert crossings installed in rights -of -ways by other affected owners of District lands, as culvert crossing, are subject to distance limitations imposed by the District 20. Ail utility installations shall be clearly' marked with above -ground signs or markets, as required by the District's "Permit Information and Criteria Manual."