Nassau County Department of Planning & Economic Opportunity Nassau Place Yulee, Florida 32097

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Nassau Cunty Department f Planning & Ecnmic Opprtunity 96161 Nassau Place Yulee, Flrida 32097 Tac E. Ppe, AICP Directr APPLICATION AND INSTRUCTIONS FOR FUTURE LAND USE AMENDMENT LESS THAN TEN (10) ACRES NOTICE: Flrida Statutes and the Curts f Flrida require that all Future Land Use Amendment applicatins be heard as a Legislative hearing (Nn Quasi-Judicial hearing). 1. The Planning and Zning Bard and the Bard f Cunty Cmmissiners will cnduct a public hearing fr this applicatin. 2. The prcedure will require that the public ntice f this applicatin be mailed t adjacent prperty wners, a legal advertisement published in the newspaper and a sign psted n the prperty. 3. The Department f Planning & Ecnmic Opprtunity will prepare a staff reprt fr the Planning and Zning Bard and fr the applicant. 4. If yu have any questins abut prcedures r the criteria, please cnsult with the Department f Planning & Ecnmic Opprtunity prir t the Planning and Zning Bard meeting. Revised Dec 2016

INSTRUCTION FOR APPLYING FOR A FUTURE LAND USE AMENDMENT LESS THAN TEN (10) ACRES It is essential that all the infrmatin prvided is accurate. Incrrect infrmatin can delay r nullify the applicatin prcess. Use the Department f Planning & Ecnmic Opprtunity frms that are available fr dwnlad at www.nassaucuntyfl.cm under Departments, Planning & Ecnmic Opprtunity, Dwnladable Applicatin frms. Please attach additinal sheets as needed, using 8½ x 11" size paper, typed r printed legibly and identifying each questin n the applicatin. The Parcel Identificatin Number is an eighteen (18) digit number defining the subject prperty. This number is lcated at the Prperty Appraiser's website at www.nassauflpa.cm. The legal descriptin f the subject prperty is shwn n the deed and the survey. If the prperty is in a recrded subdivisin, use the lt and blck number. If the prperty is nt in a recrded subdivisin, use the metes and bunds descriptin as shwn n the deed r survey. A reference t the sectin, twnship, range, r deed bk will nt be sufficient. A.txt file f the metes and bunds descriptin f the bundaries f the prperty is required. Fill in the street lcatin by indicating the prperty lcatin by side (nrth, suth, east r west) f the street and the nearest intersecting streets (fr example: west side f Amelia Rad, between Magnlia Street and Amelia Lane). If a street address has been assigned t this prperty, include such number. If it is impractical t describe the street lcatin by intersecting streets, indicate the apprximate distance t the nearest intersecting street (fr example: west side f Blackrck Rad, CR 107, 1/2 mile nrth f A1A). Prvide the name and address f the prperty wners. The wner s name shuld agree with the recrded deed. Prvide the current future land use designatin f the subject prperty. The fficial future land use map is available at www.nassauflpa.cm under Map Layers. Prvide the prpsed future land use designatin f the subject prperty. It is suggested that yu discuss the prpsed use with the Department f Planning & Ecnmic Opprtunity t be sure that the future land use designatin requested will permit the type f use desired. Althugh the Department f Planning & Ecnmic Opprtunity will prvide assistance, the designatin requested in the applicatin is entirely up t the applicant. Failure t request the prper designatin will nt be the respnsibility f Nassau Cunty. If yu find later that the designatin applied fr des nt suit yur needs, yu will nt be allwed t change the applicatin after due public ntice has been psted. An updated survey f the subject prperty is required. The survey must be prepared by a prfessinal surveyr licensed in the State f Flrida. The nn-refundable applicatin fee fr a Future Land Use Amendment is required at the time f applicatin. T cnfirm the fees, including pstage based n the number f prperty wners within 300 feet, please cntact the Department f Planning and Ecnmic Opprtunity at (904) 530-6300. Return the cmpleted applicatin, any supprting data and the applicatin fee t the Department f Planning & Ecnmic Opprtunity. Please make checks payable t: Nassau Cunty Bard f Cunty Cmmissiners (Nassau Cunty BOCC). The applicant is respnsible fr the legal advertisement payment and must be made directly with the newspaper.

Nassau Cunty requires due public ntice which includes a legal advertisement published in an apprved newspaper f general circulatin nt less than fifteen (15) days in advance f the public hearing, a sign psted in a cnspicuus place n r arund the subject prperty and a public ntice mailed t all prperty wners within 300 feet f the periphery f the subject prperty. The Department f Planning & Ecnmic Opprtunity will prepare the legal advertisement, the public ntice and the sign. If the signs are destryed r rendered illegible, ntify the Department f Planning & Ecnmic Opprtunity immediately s that a replacement can be erected. The applicant is respnsible fr delivering the riginal Prf f Publicatin frm the newspaper t the Department f Planning & Ecnmic Opprtunity. The public hearing cannt be held unless Prf f Publicatin is received by the Department f Planning & Ecnmic Opprtunity befre the public hearing. The applicant is nt required t btain the signatures r apprval f the adjining prperty wners. If yu chse t present a petitin f adjining prperty wners favring yur applicatin, attach a legibly printed r typed list f the names and addresses submitted n the petitin. The Department f Planning & Ecnmic Opprtunity will make every effrt t place yur applicatin n the agenda fr the Planning and Zning Bard s public hearing within thirty (30) days and fr the Bard f Cunty Cmmissiners within thirty (30) days subsequent t a recmmendatin being made by the Planning and Zning Bard. Hwever, the Cunty reserves the right t allw fr sixty (60) days befre an applicatin appears befre the Planning and Zning Bard, and an additinal sixty (60) days befre an applicatin appears befre the Bard f Cunty Cmmissiners fr final apprval due t the number f agenda items fr any particular public hearing, the cmplexity and legal review f thse applicatins and allwing sufficient time fr citizens, Cunty fficials and staff t discuss applicatins f public imprtance. If, fr any reasn, yu wish t withdraw the applicatin, yu must ntify the Department f Planning & Ecnmic Opprtunity, in writing, prir t the date f the public hearing. N refunds. Persns with disabilities requiring accmmdatins in rder t participate at the public hearing shuld cntact (904) 530-6300 at least twenty-fur (24) hurs in advance t request such accmmdatin. The public is invited t be present and be heard. If a persn decides t appeal any decisin made by the bard, agency r cmmissin with respect t any matter cnsidered at such meeting r hearing, he/she will need a recrd f the prceedings, and that, fr such purpse may need t ensure that a verbatim recrd f the prceedings is made. The Department f Planning & Ecnmic Opprtunity can be reached at 96161 Nassau Place, Yulee, FL 32097, and (904) 530-6300, Mnday thrugh Friday, 8:00am until 5:00pm.

APPLICATION FOR FUTURE LAND USE AMENDMENT LESS THAN TEN (10) ACRES Official Use Only Zning District: FLUM Designatin: Cmmissin District: Date Filed: - - - - - Parcel Identificatin Number (18 digit number) Driving Instructins: 1. Legal Descriptin: Lt Blck Subdivisin Plat Bk Page (Please attach a legal descriptin if nt lcated in a subdivisin) 2. Lcatin: On the side f (nrth, suth, east, west) (street) between and (street) (street) Nearest identifiable landmark (fr example: Walmart r I-95) 3. Name and Address f the Owner as shwn in the public recrds f Nassau Cunty: Name and Address f the Applicant / Authrized Agent: (PLEASE NOTE: If applicant is nt the wner, this applicatin must be accmpanied by cmpleted Owner's Authrizatin fr Agent frm.) Revised Dec 2016 1

4. Current Future Land Use Map Designatin: 5. Prpsed Future Land Use Map Designatin: 6. Acreage: 7. Prperty Use (list any imprvements n the site r uses): 8. Private Well Public Water System r Private treatment plant (name f prvider) 9. On-site Sewage Treatment System Public Water System (name f prvider) r Private Sewer Treatment Plant 10. Required Attachments: Exhibit A Lcatin Map Exhibit B Legal descriptin Exhibit C Survey NOTE: Owner, Applicant and Agent is respnsible fr required respnse t bjectins, recmmendatins and cmments frm State reviewing Agencies. In filing this applicatin, the undersigned understands it becmes a part f the fficial recrds f the Planning and Zning Bard and des hereby certify that all infrmatin cntained herein is true t the best f his/her knwledge. Signature f Owner: Signature f Applicant: (if different than Owner) Signature f Agent: (if different than Owner) Owner s mailing address: Telephne: Email: NOTE: If prepared r signed by an agent, a ntarized Owner s Authrizatin fr Agent frm must be prvided. Newspaper fr legal advertisement (OFFICIAL USE ONLY): Fernandina Beach News Leader: Nassau Cunty Recrd 2

CONSENT FOR INSPECTION I,, the wner r authrized agent fr the wner f the premises lcated at d hereby cnsent t the inspectin f said premises and the psting f public ntice by an emplyee f the Department f Planning & Ecnmic Opprtunity, Nassau Cunty, Flrida, in cnjunctin with applicatin, withut further ntice. Dated this day f, 20. Signature f Owner r Authrized Agent Telephne Number STATE OF FLORIDA: COUNTY OF NASSAU: The freging instrument was acknwledged befre me the day f, 20, by wh is persnally knwn t me r wh has prduced as identificatin. Ntary Public Signature Name (typed r printed) (Seal) 3

AGENT AUTHORIZATION (FOR COMPANY OR LLC) is hereby authrized as the Agent TO ACT ON BEHALF OF, the wner(s) f thse lands described within the attached applicatin, and as described in the attached deed r ther such prf f wnership as may be required, in applying t Nassau Cunty, Flrida, fr an applicatin pursuant t a: Rezning/Mdificatin Variance Plat Cnditinal Use Preliminary Binding Site Plan BY: Signature f Agent Print Name f Agent Agent Address Agent Email Agent Telephne Number Signature f President, Chairman f the Bard r managing partner f (Circle ne) Print Name Address Telephne Number Email I,, hereby affirm r swear that I have the authrity n behalf f (name f agent), t file the applicatin with Nassau Cunty. Initials Initials

Certificate I, (signer s name), (title) f (cmpany r LLC) an entity lawfully rganized and existing under the laws f (name f State) d hereby affirm r swear that I am empwered and authrized, n behalf f the entity, t execute this Agent Authrizatin frm, and all dcuments required by Nassau Cunty regarding this applicatin, and further expressly warrants that has been given and has received and accepted authrity t sign and execute the dcuments n behalf f. Signature Title State f Flrida Cunty f The freging instrument was acknwledged befre me this day f, by as fr. Persnally Knwn OR Prduced as identificatin. Ntary Signature My Cmmissin expires: A cp f the by-laws are attached heret. Initials Initials