(Fee is $250 or $800)

* Indicates required information
APPLICANT INFORMATION
* Applicant Name:
* Mailing Address:
* City:
* State:
* Zip:
* Phone Number:
Fax Number:
Email:
 
OWNER INFORMATION Same as above
* Owner Name:
* Mailing Address:
* City:
* State:
* Zip:
* Phone Number:
Fax Number:
Email:
 
PROJECT INFORMATION
* Project/Subdivision Name:
* Property Address:
* City:
* State:
* Zip:
 
Please list all Tax Parcel ID numbers for all properties included in this proposal/request.
* Tax Parcel I.D. #1: Look up your Parcel #
Tax Parcel I.D. #2: Look up your Parcel #
Tax Parcel I.D. #3: Look up your Parcel #
Tax Parcel I.D. #4: Look up your Parcel #
 
 
APPLICATION INFORMATION
* This application:

 
TYPES OF FINAL DEVELOPMENT ORDERS
If submitted with a development application, select the type of development order applied for below:
Concurrency Review is:
 
FOR SEMINOLE COUNTY SCHOOLBOARD USE ONLY
PROVISION OF PUBLIC FACILITIES / SERVICE TO SCHOOL SITE
This proposal:
 
* A Signed and Sealed Traffic Impact Study is:
Land uses which require a traffic study regardless of size are convenience stores, gasoline stations, banks, and fast food restaurants.
DELIVERED OR MAILED : study prepared pursuant to previous methodology review meeting with County Engineer. Select the type below, if listed:
NOT REQUIRED: since this application is specifically for:
   
*Utility Service Provision:
a) Water Service (Utility Provider): Served by
Not Served.
b) Sewer Service (Utility Provider): Served by
Not Served.
c) Landscape Irrigation System:

Will this project use Potable Water for Landscape Irrigation?

  No
Yes over an irrigated landscape area of square feet.
  At an applicable rate of: inches/week,
and gpd.
   
A Water and Sewer Demand Estimate Prepared By a Certified Engineer is:
DELIVERED OR MAILED.
NOT INCLUDED: I understand that Seminole County will make an estimate of water and sewer demand based upon the information in this application, but that I am solely responsible for assuring the accuracy of demand calculations for the purpose of paying connection fees. If sufficient data to perform an accurate demand calculation is not provided, applicants engineer will need to meet with the County Environmental Services Division prior to completing a utility agreement and payment of fees to determine a final demand calculation.
 
* PROJECT SIZE AND PHASING:
Below, clearly identify past or existing uses or structures, if applicable, and proposed new development/construction. Credit for prior uses can only be given if the information is clear and complete. (Note: Sizes, types, and number of units as filled out below and as indicated on the plans will be assumed as maximums for estimating project demand and the Certificate of Concurrency will be conditioned upon and only valid for such maximums provided on this application)
PHASE
Number of Phases
(if applicable) 		NUMBER OF ACRES SPECIFIC USE (S) BUILDING GROSS
SQUARE FEET or
NUMBER OF
UNITS / LOTS
Example: Phase I 15 Single Family 95 Units
 
CERTIFICATION

I hereby certify that the information contained herein is true and correct and that I am either the true and sole owner of the subject property, or am authorized to act on behalf of the true owner(s) in all regards on this matter, pursuant to proof and authorization submitted with the corresponding development application or attached hereto. I hereby represent that I have the lawful right and authority to file this application.

I understand that submission of the form initiates a process and does not imply approval by Seminole County. I further understand that issuance of a Certificate of Concurrency will require successful completion of Development Review and payment of Facility Reservation Fees, and that likewise no final development order will be issued except upon successful completion of this Concurrency Review. I further understand that “Inquiry Only” Review will result in no Certificate of Concurrency being issued, and therefore no binding assurance of future capacity, and that a new Concurrency Review application will be required in conjunction with the first final development order applies for on this property.
* I have read and agree with the statements above.