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Residential Driveway Permit Application

2. NOTICE
   ELECTRICAL POWER AND CERTIFICATE OF OCCUPANCY WILL NOT BE ISSUED UNTIL DRIVEWAY CONSTRUCTION AND MAILBOX PLACEMENT HAS BEEN APPROVED.

   ELECTRICAL POWER AND CERTIFICATE OF OCCUPANCY WILL NOT BE ISSUED UNTIL DRIVEWAY CONSTRUCTION AND MAILBOX PLACEMENT HAS BEEN APPROVED.

4. ROAD-MAINTAINER CONFIRMATION
   Road-Maintainer Application

   No county driveway permit is required if your attaching onto a state, city, or private road. Please use the link just above to confirm you property abuts a county-maintained roadway if you have not already done so.

6. ROAD SURFACE*

   1. Dirt
   2. Paved

8. IS YOUR DRIVEWAY*

   1. New
   2. Existing

10. DO YOU PROPOSE*

    1. Culvert
    2. Swale
    3. Curb and Gutter
    4. Flat

12. BUILDING PROJECT NUMBER

14. APPLICANT NAME*

16. APPLICANT TELEPHONE NUMBER*

18. APPLICANT E-MAIL ADDRESS*

20. PARCEL NUMBER*

    (If you do not have your parcel number, please visit http://www.srcpa.org/search.html. Parcel number is required.)

22. CONSTRUCTION ADDRESS*

24. PROCEDURES ACKNOWLEDGEMENT
    Driveway Permits

    By submitting this application, the applicant acknowledges that they have read the Driveway Permits Page for procedures for residential driveway permits.

26. MARKING ACKNOWLEDGEMENT
    By submitting this application, the applicant acknowledges the driveway location must be obviously staked, painted, and or marked clearly prior to the submission of this application.

    By submitting this application, the applicant acknowledges the driveway location must be obviously staked, painted, and or marked clearly prior to the submission of this application.

28. MAILBOX ACKNOWLEDGEMENT
    Ordinance Number 2006-03

    I have read “Ordinance Number 2006-03”. I understand I must contact the property’s local post office regarding the allowance of a mailbox at the property.

30. PROPERTY OWNER NAME*

    (If different from applicant information above)

32. E-MAIL ADDRESS

34. MAILING ADDRESS

36. MAILING CITY, STATE, AND ZIP CODE

38. DISCLAIMER STATEMENT
    The driveway(s) will be constructed in accordance with county regulations in effect at the time the permit is issued. The applicant will save and keep Santa Rosa County harmless from any and all damages, claims or injuries that may occur by reason of this construction of said facility. The applicant binds and obligates himself that the above description and attached sketch are true and correct and to abide by the driveway regulations of Santa Rosa County. By submitting this document, applicant acknowledges all terms and agreements herein.

    The driveway(s) will be constructed in accordance with county regulations in effect at the time the permit is issued. The applicant will save and keep Santa Rosa County harmless from any and all damages, claims or injuries that may occur by reason of this construction of said facility. The applicant binds and obligates himself that the above description and attached sketch are true and correct and to abide by the driveway regulations of Santa Rosa County. By submitting this document, applicant acknowledges all terms and agreements herein.

40. REQUIRED CONSTRUCTION PLANS SKETCH*

    Please include property, street, and driveway with dimensions and plans.

42. REQUESTING FUTURE INSPECTIONS
    Request a Driveway Inspection

    The submission of this form will prompt your first inspection. For future inspections, please use form "Request a Driveway Inspection" just above.

44. If Public Works may assist you in the completion or submission of this application, please contact us at PublicWorksAdminTeam@santarosa.fl.gov

    If Public Works may assist you in the completion or submission of this application, please contact us at PublicWorksAdminTeam@santarosa.fl.gov

Leave This Blank:


46. 1. Receive an email copy of this form.
47. Email address

    This field is not part of the form submission.

48. Submit

* indicates a required field