SAMPLE REQUEST FOR ESTABLISHMENT OF MSBU

(Public Owned Sewer System)

December19, 2005

Board of County Commissioners

Santa Rosa County

6495 Caroline Street, Suite M

Milton, FL 32570

Dear Board of County Commissioners,

We/I the homeowner(s) of Quiet Street (or Quiet Street subdivision) request that a Municipal Service Benefit Unit (MSBU) be established for the purpose of installing and maintaining a sewer system in the Quiet Street Subdivision. We would like to have the sewer system installed from Bird Whistle Street, where the connection will be made to ABC Utility Company’s main line, and run throughout our entire subdivision.

I have included a written cost estimate for the project that was provided to me by XYZ Engineering Inc. It is understood that this is just an estimate and when the job is actually bid out, the cost may vary.

I will be the point of contact for all correspondence and will ensure the County-prepared petitions are circulated and returned. I have received and understand the Policies and Procedures to establish an MSBU.

Sincerely,

John Q. Public

Mr. John Q. Public

1234 Quiet Street

Navarre, FL 32566

Phone: 939-1234