Town of Mangonia Park

Submittal Date: ______

Application No: ______

Name of Project: ______

TOWN OF MANGONIA PARK

1755 E Tiffany Drive

Mangonia Park, FL 33407

Phone: (561) 848-1235

Fax: (561) 848-6940

****This Application Must Be Typed****

Project Name: ______

Location: ______

Legal Description: ______

Owner: ______

Address: ______

Telephone: ______

Engineer/Architect/Planner: ______

Address: ______

Telephone: ______

Type of Development Proposed:______

Residential: Number of Units ______Bedrooms per Unit ______

Non-Residential: Acres ______Sq. Ft. Building Space ______

Staff Comments:

Date submitted: ______

Traffic Report: ______

Sanitary Sewer/Potable Water Confirmation: ______

Solid Waste Confirmation: ______

Drainage Statement:: ______

Recreation and Open Space Confirmation: ______

Fee: ______

Wellfield Certification: ______

Traffic Report: Submit a traffic report signed and sealed by an engineer registered in the State of Florida documenting that the development is in compliance with the Palm Beach County Traffic Performance Standards (2 copies).

Sanitary Sewer & Potable Water Demand: The adopted level of service is 100 gallons per day per person residential (two persons per dwelling unit for units of two bedrooms or less, and an additional person for each bedroom thereafter); 2,500 gallons per acre per day for non-residential. Estimated daily demand for this development ______. The applicant shall submit a letter signed by the Utilities Department confirming that this facility has capacity to serve the development prior to issuance of a building permit. This letter shall include the estimated daily demand based on adopted levels of service entered on this application.

Solid Waste: The adopted level of service for solid waste is 869 pounds per capita per year for residential use (two Persons per dwelling unit for units of two bedrooms or less, and an additional person for each bedroom thereafter); 12 tons per acre per year for non-residential use. Estimated yearly solid waste demand: ______. The applicant shall have the attached letter signed by Florida Sanitation, Inc., of Palm Beach County and returned to Mangonia Park’s Town Manager.

Drainage: The adopted level of service for drainage is retention on-site of 3.2” rain, the equivalent of a five-year, one hour storm. A drainage statement signed and sealed by an engineer registered in the State of Florida documenting that the project meets this requirement shall be submitted with this application (2 copies).

Recreation and Open Space: (residential only) The adopted level of service for recreation and open space four acres per 1,000 population. The Town Manager will confirm that the population of this project can be accommodated by existing facilities or that the project provides sufficient facilities to meet this requirement.

Wellfield Protection: The applicant certifies that they have read the Palm Beach County Protection Ordinance and the proposed development is in compliance with said ordinance.

Development Name: ______

Residential:

Number of Dwelling Units ______

Number of Bedrooms Per Unit

(Assume two persons per dwelling unit for

units of two bedrooms or less, and an

additional person for each dwelling unit

thereafter) ______

Number of Persons in this

Residential Development (the

adopted level of service for

solid waste is 869 pounds per

person per year for residential use) ______

Pounds per year of solid waste ______

Non-Residential:

Number of Acres ______

(The adopted level of service is 12 tons

per acre per year for non-residential use.)

Tons per year of solid waste ______

Send this completed form to:

Waste Management of PBC, Inc.

Attention: Concurrency Confirmation Department

651 Industrial Way

Boynton Beach, FL 33436

Waste Management of PBC, Inc. confirms by this instrument that it has the capacity to serve the ______development and will collect the ______tons of solid waste it is estimated to generate at such time as this service is necessary.

I, ______, being first duly worn, depose and say that I am the engineer, architect or planner of the property described herein and which is the subject of this concurrency review, that all answers to the questions in this application and all attachments made a part of this application are honest and true to the best of my knowledge and belief. I understand that this application must be completed and accurate before a site plan will be approved.

______

Signature

State of Florida

County of Palm Beach

Sworn to and subscribed before me this ______

day of ______, ______by

______who is personally

known to me or has produced identification.

(SEAL)

______

Signature of Notary

Board Action Meeting Date: ______

Concurrency: ______

Findings of Fact: ______

______

______

______

______

______

______

______

Concurrency was ____ Granted ____ Denied, on ______

Conditions Imposed: ______

______

______

______

______

______

______

______

______

______

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Revised 06/03/04