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2. Date Received: ______________________
3. Application No. _______________________
4. Fee Received ______________
6. NOTICE TO APPLICANT
   1. Processing will not be started, and the application will not be officially accepted until all the following items have been completed. The applicant or his/her authorized representative must be present at any requested meeting and any requested public hearing considering the the application and it is the duty of the applicant or his/her authorized representative to obtain the time, date, and place of all public hearings and/or meetings at the Office of the City Clerk. Failure to appear shall be sufficient cause to deny the request due to lack of evidence.
8. 2. Electronic Plan Submittal: Please submit an electronic disc (CD) in PDF format containing the application, attachments and all plans. In addition, submit three (3) paper copies of the same. (Additional copies may be requested.)

   A. APPLICATION : The application must be complete and accompanied by the non-refundable filing fee.

   B. REPLAT: Folded. Must meet the Clerk of Circuit Court requirements for recording. Engineering plans shall meet requirements of the City Oldsmar City Engineer and Public Works Director.

   C. CONTINUOUS LAND STATEMENT: State as to whether or not the owner applicant has a proprierty interest, or in any way has other contractual interest in any land which is contiguous to the land which is the subject of this request. If so, also attach a legal description of the property and identify as "Additional Land Holdings in the Area." State the interest in such land.

   D. CERTIFICATE OF OWNERSHIP: Submit a certificate from a duly licensed title or abstract company or a licensed attorney-at-law showing that the owner is the -resent titleholder of record. (WARRANTY DEEDS, TITLE INSURANCE DOCUMENTS, TAX INSURANCE DOCUMENTS, TAX RECEIPTS, ETC., ARE NOT ACCEPTABLE AS PROOF OF OWNERSHIP)

   E. CERTIFICATE FROM OWNER OF RECORD: Certificate from the owner of record that the applicant has the authority to submit this application f the applicant is not the property owner.

   F. LIST OF SURROUNDING PROPERTY OWNERS WITHIN 200' ON LABELS: This may be obtained from the Pinellas County Property Appraisers Office.

   G. LEGAL DESCRIPTION OF THE PROPERTY: Please include this with the application.

   H. CERTIFIED BOUNDARY SURVEY OF THE PROPERTY: Survey must be current, within the last 12 months, and sealed. 

   I. DECLARATIONS OF COVENANTS AND RESTRICTIONS: Provide if applicable.

10. ***Upon approval you will need to complete and record the Parcel Split Request Form (http://www.pcpao.org/ParcelSPLIT.pdf). This form requires you to submit the surveys of each lot after the split. Also Include the City's approval letter.***
    Parcel Split Form
14. APPLICANT/OWNER INFORMATION
16. Applicant Name
17. Address
18. Phone Number
20. Email
22. Owner's Name
23. Phone Number
24. Owner's Mailing address
26. Email
28. Surveyor/Enginer Name
29. Surveyor/Engineer Mailing Address
30. Phone Number
32. Email
33. Fax Number
37. Property Information
39. Subdivision Name
40. Number of Lots
41. Types of Lots
43. Minimum Lot Size
44. Property Street Address
45. Property Size
    in Acres
47. Present Use
48. Proposed Use
49. Present Land Use
50. Present Zoning
52. Provide a general Description
    (address, number of units, density, land area, type of commercial or industrial uses proposed)
53. Parcel ID No. and Legal Description
55. List Any and All Encumbrances on the Property
56. Projected Date of Build-Out
58. Projected Completion Date of Each Phase
60. Physical Features and Flooding
62. List any Outstanding Physical Features of the Property
    (i.e. soils, topography, wetlands, or other preservation or conservation designations)
63. Flood Zone Designation
64. Base Flood Elevation
66. Does any part of the property lie under water or in a 100 year flood zone?

    1. Yes
    2. No
67. If yes, provide relevant details
69. Public Improvements
71. Indicate whether construction of improvements have been completed. If construction improvements have not been completed, please indicate the types and status of the performance guarantee to be submitted to the city prior to city council action on the final plat.

    1. All construction improvements have been completed

    1. Construction improvements have not been completed
73. Select All Applicable Improvements

    1. Streets
    2. Street Lights
    3. Sidewalks
    4. Water System
    5. Sanitary Sewer System
    6. Stormwater Drainage
    7. Reclaimed Water System
74. Are street improvement completed?

    1. Yes
    2. No
75. Are street light improvements completed?

    1. Yes
    2. No
77. Are sidewalk improvements completed?

    1. Yes
    2. No
78. Are water system improvements completed?

    1. Yes
    2. No
79. Are sanitary sewer system improvements completed?

    1. Yes
    2. No
80. Are stormwater drainage improvements completed?

    1. Yes
    2. No
82. Are reclaimed water system improvements completed?

    1. Yes
    2. No
84. Status of the street improvements
85. Status of the street lights improvements
87. Status of the sidewalk improvements
88. Status of the water system improvements
90. Status of the sanitary sewer system improvements
91. Status of the stormwater drainage improvements
93. Status of the reclaimed water system improvements
95. The following conditions must be met for the application review to proceed:

    No new streets are proposed or additional right-of-way is needed.

    No vacation or elimination of streets, access control, or easements are required or proposed.

    No significant increases in service requirements or interference with maintenance of existing levels of service shall occur.

    No tract or lot will be left without direct street access.

    No non-conforming lot, by either dimension or area as prescribed by the zoning district, shall be allowed.

    All easement requirements must be satisfied prior to scheduling city council final approval.

    It is the applicant/owner responsibility to record the final plat or replat with the Pinellas County Clerk of the Circuit Court.

97. I HEREBY CERTIFY that I have read and understand the contents of this application, and that this application together with all supplemental data and information is a true representation of the facts concerning this request; that this application is made with my approval, as owner and applicant, as evidenced by my signature below. it is hereby acknowledged that the filing of this application does not constitute automatic approval of the request; and further that if the request is approved, I will obtain all necessary permits and comply with all applicable orders, codes, conditions, rules, and regulations pertaining to the use of the subject property.
99. Date: ___________________________________
100. _______________________________________________________________________

     Signature of Owner or Owner's Authorized Representative

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