HomeMy WebLinkAboutRIGHT OF WAY ACCESS PAPERWORKDistrict Use Only: No: --QQ —_ -
NORTH ST. LUCIE RIVER WATER CONTROL DISTRICT
("District") SCANNED
14666 Orange Avenue • Fort Pierce, Florida 34945 • (772) 461-5050 • FAX (772) 461-9446 BY
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Application to Connect to or Use District Facilities, or for Utility Construction . Lucie County
A. General Information:
Applicaq Information:
Nam e• Yl a
Address: T • �i . VL,�:. ��� c (0
)Engineer of Record Information (if aoDlicable):
Telephone: f )
Email:
Owner Information.fif different from Applicant):
Name.
Address:
Telephone:
Billing Contact Information:
Telephone: ( )
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 Television. ❑ Water Main ❑ Force Main
Q/Other(specify): RFQa* ne QLi
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Location: Section(s): J Township: ;d Range: _22 �F— Canal No.: -
Description of Indirect Connection:
Drainage area served: acres (Culvert or pump Connections.)
C. Construction Schedule:
Estimated commencement date: Cet i��Estimated completion date: � —1
D. Application, Use Fee: $ Review Deposit: $
(Submit fee with this application in accordance with the District's fee schedule.)
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 properly and
non-paymenburay-toattit infiling of a construction lion as permitted by the Florida Statutes.
Owner Signature: F Owner Name (Type F
Date: r) I ^ 1 L4 —
0 of3)
District Use Only: No. - i 9 - -00-L- - S 3
NORTH ST. LUCIE RIVER WATER CONTROL DISTRICT
("District")
14666 Orange Avenue < Fort Pierce, Florida 34945 • (772) 461-5050 * FAX (772) 461-9446
Application to Connect to or Use District Facilities, or for Utility Construction*
SPECIAL CONDITIONS: for District Use Only):
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Application Approved and Permit for Construction Issued:
BY: ` �Xi�A e� Date of Approval: `q
For the North St. Lucie River Water Control District
Permit Expiration Darr. Construction Expiration Date:
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Project Certification Received and Accepted:
BY: Date of
For the North SL Lucie River Water Control District
Certification Expiration Date:
*This Applicarion mill became a Pernth ifand when approved and slgned by an aaborized represenraive of the District.
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(2 of 3)
STANDARD PROVISIONS
for
Application f Permit No. /9l R - CO/ - S3
If this Application for a Permit is approved I do acknowledge, 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 of, 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 rn for 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 669 at page 699 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 0oodiog 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 from the Pemriaee to a subsequent owner or ovnters of all, or a
portion of, 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 am 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.
10.1 accept total responsibility for any erosion of, or shoaling in, the District's 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,) shall prevent material firm 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 work 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 2.0 inches of depth over die area for any 24-hour period (38 gallons per minute per acre) from the 10-year
frequency, 72-hour duration rainfall.
IS. 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 work in a manner that will not impair the use, or potential use, of the
District right-of-way and facilities. 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 Permince is advised that the crossing
may be permitted for use by other affected owners, as such crossings we 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 crossings are subject to distance limitations imposed by the District.
20. All utility installations shall be clearly marked with above -ground signs or markers, as required by the District's "Permit
Information and Criteria Manual.'