APPLICATION FOR SURFACE WATER ASSESSMENT ADJUSTMENT
 
FOR QUESTIONS OR APPPOINTMENTS, PLEASE CALL (727) 464-8759
SECTION A - APPLICANT INFORMATION

SECTION B - PROPERTY INFORMATION

SECTION C – DETAILS OF REQUEST FOR ADJUSTMENT
Type of Property *


SECTION D – APPLICATION CHECKLIST
  • Complete application requesting an Adjustment
  • Evidence supporting the basis for the adjustments (photos, plans, etc) including the opinion of a certified professional engineer or surveyor where applicable
Incomplete applications will be denied and must be resubmitted. Please note that the County reserves the right to request additional information if necessary.

SECTION E – CERTIFICATION STATEMENTS
CLICK BELOW CERTIFYING THAT YOU HAVE READ THE FOLLOWING STATEMENTS AND UNDERSTAND EACH ONE: (By clicking and submitting you have electronically signed this application) *
I hereby grant the Pinellas County access to the property referenced in this document to confirm any of the information stated in this application to determine my adjustment. *
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OPTIONAL
If you have submitted this certification as a Florida Registered Professional, you may wish to sign and seal this certification, and return a copy to the Department, in accordance with your professional practice act requirements under Florida Statutes.
Do hereby certify that the above information is true and accurate, based upon my knowledge, information and belief.

E-mail addresses are public records under Florida law and are not exempt from public-records requirements. If you do not want your e-mail address to be subject to being released pursuant to a public-records request, do not send electronic mail to this entity. Instead, contact this office by telephone (727) 464-8759
or in writing, via the United States Postal Service to:

Pinellas County Surface Water Assessment
22211 US 19 N – Building 10
Clearwater, FL  33765