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


SECTION B - APPLICANT’S ENGINEER/ Surveyor

SECTION C - PROPERTY INFORMATION

SECTION D – MITIGATION CREDIT ELIGIBILITY
Check Mitigation Credit Category Applicable to the Property: *


SECTION E – APPLICATION CHECKLIST

Completed applications must be submitted by April 1st of each tax year. The subject stormwater management system must be in compliance with all applicable site plans and permits to be considered. Contact Pinellas County at 727-464-8759 for more information. Please note that the County reserves the right to request additional information if necessary.

PLEASE INCLUDE ALL OF THE FOLLOWING (CHECK OFF): *
For parcels discharging to eligible Tidal Waters:
All items above and, *

SECTION F – 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) 
  • The information in this application is truthful and accurate.
  • The stormwater management system presented in this application is not currently enrolled in the Pinellas County Adopt-A- Pond Program.
  • The credited stormwater management system will stay in compliance with its site plan and permit requirements.
  • I hereby grant Pinellas County staff access to the property referenced in this document to inspect the facility or facilities proposed for a mitigation credit.
  • I will notify Pinellas County should any destruction or damage occur to the facility referenced in this mitigation credit application that prevents it from performing as credited.
  • The credited stormwater management system complies with and is maintained in accordance with all permit and site plan requirements.
 *
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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. *

Engineer/Surveyor Certification
Application must be signed and sealed by a Professional Engineer or Surveyor licensed in the State of Florida.  Include a copy of your seal 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.
Affix signature, date, seal, company name, address and certificate of authorization. 
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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