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2. WATER/ WASTEWATER ANNEXATION

   USE THIS FORM TO: Request the City Commission’s authorization to extend water and/or sanitary wastewater services to property not located within the City limits and not currently eligible for annexation.

   This application must also  include the Voluntary Annexation Agreement / Petition for Annexation, as required by Municipal Code prior to the extension of services outside the City’s jurisdiction.

4. Fees

   1. $300
6. IMPORTANT NOTES

   Per Municipal Code Sections 82-44 and 82-403, the extension of City water and/or sanitary sewer services to property located outside the municipal limits must be authorized by the City Commission. Application for these services shall be placed on the next available City Commission agenda. The City Commission meets the 1st and 3rd Tuesday of each month at 6:00PM. Applications must be received three (3) weeks prior to the requested agenda.

   This application must also  include the Voluntary Annexation Agreement / Petition for Annexation, as required by Municipal Code prior to the extension of services outside the City’s jurisdiction.

8. PROPERTY INFORMATION
   Property information can be found at the Nassau County Property Appraiser’s Website → Map Search
10. Site Address*
12. Parcel ID #(s)*
14. OWNER OF RECORD

    ALL NAMES, as recorded with the Nassau County Property Appraiser

16. First Name*
17. Last Name*
19. Company (if applicable)
21. Mailing Address*
23. Telephone Number*
24. E-mail Address*
26. OWNER'S AGENT
    If an agent will be representing the owner, an Owner’s Authorization For Agent Representation form must be included
28. First Name
29. Last Name
31. Company (if applicable)
33. Mailing Address
35. City
36. State
37. Zip
39. Telephone Number
40. E-mail Address
42. PROJECT INFORMATION
44. Total Number of Lots/Parcels*
45. < One (1) acre sq. footage*
46. > One (1) acre sq. footage*
48. Existing Zoning Classification*
49. Existing Future Land Use Classification
51. Description of Request*
53. Have you filled out and attached the Annexation Petition Agreement?*

    1. Yes
    2. No
54. If not, please click the link below to download, fill out and attach to this application:
    Voluntary Annexation Agreement / Petition for Annexation
56. Upload Supporting Documentation
57. Upload 2
58. Upload 3
60. Upload 4
61. Upload 5
63. Certification*

    1. By signing below, I certify that the information contained in this application is true and correct to the best of my knowledge at the time of the application.
    2. I acknowledge that I understand and have complied with all of the submittal requirements and procedures.
65. Applicant's First Name*
66. Applicant's Last Name*
68. Today's Date*
    Today's Date
70. 
72. DEPARTMENT OF PLANNING & CONSERVATION

    204 Ash Street | Fernandina Beach Florida 32604 | 904 310-3480 | www.fbfl.us/planning

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74. 1. Receive an email copy of this form.
75. Email address

    This field is not part of the form submission.

76. Submit Submit and Print

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