BOARD OF COUNTY COMMISSIONERS OF SARASOTA COUNTY, FLORIDA

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APPENDIX C21 APPLICATION FOR VARIANCE AND COVENANT RUNNING WITH THE LAND Application No. BOARD OF COUNTY COMMISSIONERS OF SARASOTA COUNTY, FLORIDA FROM THE LAND DEVELOPMENT REGULATIONS, ORDINANCE 81-12, AS AMENDED Applicant s name address and telephone number: Legal description of property: Street name requiring variance INSTRUCTIONS Complete Variance Application and Covenant Running with the Land. Both documents must have the signatures of the property owner(s) and two witnesses for each signature. Submit with a non-refundable filing fee of $515.00 (includes $15 Records Fee) to Sarasota County Planning and Development Services 1001 Sarasota Center Blvd Sarasota, Florida 34240 (Please make checks payable to the Board of County Commissioners) Upon approval, applicant must have variance, affidavit and covenant running with the land recorded by the Clerk of Circuit Court of Sarasota County. A copy of the recorded document must be provided to Sarasota County Planning and Development Services prior to the issuance of the Building Permit. FormIPS26 Revised 1/12/11

APPENDIX C21 APPLICATION NO. - -DV BOARD OF COUNTY COMMISSIONERS OF SARASOTA COUNTY, FLORIDA APPLICATION FOR VARIANCE FROM THE LAND DEVELOPMENT REGULATIONS, ORDINANCE 81-12, AS AMENDED DATE FILED: IT IS REQUESTED THAT THE BOARD OF COUNTY COMMISSIONERS OF SARASOTA COUNTY, FLORIDA consider a variance in accordance with Ordinance No. 81-12, as amended, the Land Development Regulations. All petitions for variances to this Ordinance must specifically address items found on Page 63, Section 74-91(a)(1) a.-e. of this Ordinance as listed: a. That special conditions and circumstances exist which are peculiar to the land, structures, or required Improvements involved; b. That a literal interpretation of the provisions of these Regulations would deprive the applicant of reasonable use of his property; c. That the special conditions and circumstances do not result from the actions of the applicant; d. That the granting of the variance requested will not confer on the applicant any special privilege that is denied by these Regulations to other lands, structures, or required improvements under similar conditions. No preexisting conditions on neighboring lands, which are contrary to these Regulations, shall be considered grounds for the issuance of a variance; e. That, with respect to a right-of-way or improvement requirement, such requirement does not bear a reasonable relationship or rational nexus between the need for additional capital facilities and the demands generated by the development along with other development within the area. FormIPS26 Revised 1/12/11 2 APPENDIX C21 - CONTINUED

APPLICATION NO. - -DV AFFIDAVIT Section 74-151 of Sarasota County Ordinance No. 81-12, as amended STATE OF FLORIDA COUNTY OF SARASOTA Before me, the undersigned officer duly authorized to administer, personally appeared presently residing at (hereinafter referred to as affiants whether singular or plural) who after being duly sworn state: 1. That the affiants own certain real property located In Sarasota County, Florida, more particularly described as follows; to-wit: 2. That affiants have made application to Sarasota County, Florida for issuance of a building permit authorizing the construction of a residence on the property hereinabove described under circumstances, which make provisions of Section 74-151, Sarasota County Ordinance No. 81-12, as amended applicable. 3. That the affiants intend in good faith to construct a home upon the property hereinabove described, which upon completion will be occupied by the affiants as a personal residence. 4. That affiants recognize that access to the above-described property and drainage are substandard and that Sarasota County will not guarantee access, nor that a septic tank and drainfield will continue to function after initial construction due to inadequate maintenance of drainageways. 5. Affiants hereby acknowledge that: a. Development by the affiant and others along a substandard access road to the above described property may result in seriously impaired access to the above described FormIPS26 Revised 1/12/11 3

Sarasota County shall not be responsible for maintenance of the street involved or its associated drainage until same has been improved or constructed by the property owners served thereby in accordance with the standards of the Sarasota County Land Development Regulations and thereafter accepted by the Board of County Commissioners. b. If the substandard access road is within a public dedicated right-of-way no construction improvements or work may be performed by any individual without prior issuance of a Right-of-Way Use Permit pursuant to Ordinance No. 81-12, as amended. Sarasota County has no liability or responsibility for any construction, improvements, or work performed on said street by private individuals. c. This affidavit shall be recorded in the Public Records of Sarasota County, Florida, by the Clerk of the Circuit Court and shall be binding upon the affiants, their heirs, successors, assignees, grantees, purchasers for value and successors in interest of the above described real property and shall constitute a covenant running with the land. STATE OF FLORIDA COUNTY OF SARASOTA Signed and Sealed in the presence of these witnesses: Owner #1 Witness #1 Witness #2 Print Name: Print Name: Print Name: Owner #2 Witness #1 Witness #2 Print Name: Print Name: Print Name: STATE OF COUNTY OF The foregoing instrument was acknowledged before me this day of, 20, by and who is/are personally known to me or who has/have produced as identification and who did not take an oath. If no type of identification is indicated, the above named person(s) is/are personally known to me. Notary Public My commission expires: APPENDIX C21 COVENANT RUNNING WITH THE LAND FormIPS26 Revised 1/12/11 4

THIS COVENANT RUNNING WITH THE LAND is made this day of, 20 by, (a single/married man/woman), hereinafter referred to as Owner. RECITALS 1. Owner is the owner of certain real property located in Sarasota County, Florida, more particularly described in the attached Exhibit A, located at, the Property. 2. Owner has submitted to Sarasota County, a political subdivision of the State of Florida, County, a permit application for the construction of on the Property. Pursuant to said permit application, Owner has requested or intends to request that the County to issue a building permit in accordance with the permit application. 3. The Property is accessed by and/or fronts on an unimproved road, (name of road). NOW, THEREFORE, in consideration of the County approving the permit application and issuing the necessary building permits and for other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged by Owner, and to comply with Ordinance No. 81-12, as amended, Owner hereby covenants and agrees as follows: 1. Pursuant to Ordinance No. 81-12, as amended, the Sarasota County Land Development Regulations, Owner hereby affirms that Owner is responsible for maintaining and shall maintain that portion of (name of road) as described in Exhibit B that the Property relies upon for accesses and/or fronts on, in accordance with all applicable laws and regulations. 2. Owner hereby releases the County, the Board of County Commissioners, and the employees and agents of the County from any and all claims, demands, actions and judgments whatsoever, arising as a result of Owner s maintenance of (name of road). APPENDIX C21 CONTINUED FormIPS26 Revised 1/12/11 5

3. This covenant and release shall bind Owner, its successors and assigns, and shall be a covenant running with and encumbering the Property. 4. This Covenant may be terminated by an instrument executed by the Chairman of the Board of County Commissioners and recorded in the Public Records of the County. IN WITNESS WHEREOF, the undersigned has executed this Covenant Running With the Land the date and year first above written. Owner #1 Owner #2 Witness #1 Witness #1 Witness #2 Print Name: Witness #2 Print Name: STATE OF COUNTY OF The foregoing instrument was acknowledged before me this day of, 20, by and who is/are personally known to me or who has/have produced as identification and who did not take an oath. If no type of identification is indicated, the above named person(s) is/are personally known to me. Notary Public My commission expires: FormIPS26 Revised 1/12/11 6