APPLICATION FOR STANDARD LEASE
	OF PUBLIC TRUST TIDELANDS

SECRETARY OF STATE	No. _______
Public Lands Division
Post Office Box 97
Gulfport  MS  39502-0097
(228) 864-0254

1.	APPLICATION BY:
                     
┌───┐           ┌───┐            ┌───┐            ┌───┐
│   │Individual │   │Partnership │   │Corporation │   │Public Agency
└───┘           └───┘            └───┘            └───┘

Applicant's Name ________________________________________________

Address _________________________________________________________

   _________________________________________________________

Telephone (   )___________________  (   )__________________
                    Business                  Other

2.	APPLICANT'S ATTORNEY AND/OR AUTHORIZED AGENT (if any)

Name  ___________________________________________________________

Address _________________________________________________________

        _________________________________________________________

Telephone (   )___________________

3.	GEOGRAPHIC LOCATION OF SUBMERGED LAND:  (Attach vicinity map - preferably a reproduction of appropriate portion of current United States Geological Survey Quadrangle Map)

Section______  Township______  Range______  County_______________

Nearest City/Community __________________________________________

Name of Waterbody _______________________________________________

Estimated area of project (square feet) _________________________

4.	USE OF TIDELANDS:
┌───┐                            ┌───┐
     │   │Commercial                  │   │Private
     ├───┤                            ├───┤
     │   │Industrial                  │   │Public
     ├───┤                            ├───┤
     │   │Residential                 │   │Other (explain)____________
     ├───┤                            └───┘
     │   │Recreational                     ___________________________
     └───┘

5.	CONSTRUCTION OF PROPOSED IMPROVEMENTS:
┌───┐ 			┌───┐
     │   │New            │   │Renovation/Expansion
     └───┘               └───┘
┌───┐
     │   │Boat Slip		Length________  Width________  Depth_________
     ├───┤
     │   │Marina		Length________  Width________  Depth_________
     ├───┤
     │   │Wharf-Pier	Length________  Width________  Depth_________
     ├───┤
     │   │Docking		Length________  Width________  Depth_________
     ├───┤
     │   │Other (explain) ____________________________________________
     └───┘
          ____________________________________________________________

6.	PROJECT SCHEDULE:

Proposed start date _____________________________________________

Proposed completion date ________________________________________

Estimated cost of project _______________________________________

7.	RIPARIAN OWNERSHIP:  (Attach true copy of evidence of title for upland riparian property or, if applicable, notarized assignment and assignor's evidence of title)

Upland Riparian Owner (if different from applicant):

Name ____________________________________________________________

Address _________________________________________________________

        _________________________________________________________

Telephone (   )_______________  (   )________________
                    Business              Other

8.	LOCATION OF RIPARIAN PROPERTY:

Subdivision, Block and Lot Number _______________________________

Assessor's Parcel No. ____________  Size (square feet) __________

Zoning Classification ___________________________________________

Will tidelands project necessitate change in present upland zoning classification?  ______  If yes, please list any rezoning change(s), indicating status of approval.  ______________________

_________________________________________________________________

Improvements on upland riparian parcel (describe) _______________

_________________________________________________________________

_________________________________________________________________

Value of upland riparian parcel as listed on County Tax Assessor's roll ___________________

9.	DESCRIBE ALL ACTIVITIES TO BE CONDUCTED ON THE LEASED PROPERTY.

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

If the property to be leased is to be used for any purpose other than single family residential property, attach two (2) prints of a survey prepared, signed and sealed by a person properly registered as a land surveyor by the Mississippi State Board of Registration for Professional Engineers and Land Surveyors with the following requirements:

(1)	Utilizing an appropriate scale on 8½" x 11" size paper, unless a larger size is necessary to provide sufficient clarity and detail;

(2)	Showing the line of mean high tide, if any;

(3)	Showing the location of shoreline and submerged vegetation, if any;

(4)	Showing the location of any proposed structures and all existing structures, if any;
(5)	Showing the applicant's or assignor's upland parcel property lines, if property to be leased abuts on property which is outside the public trust;

(6)	Showing the primary navigation channels or direction to the center of the affected waterbody; and

(7)	Including a legal description of area to be leased with State Plane coordinates of reference point.

If the property to be leased is to be used as a single family residential property, attach two (2) copies of dimensioned site plan drawing(s) with the following requirements:

(1)	Utilizing an appropriate scale on 8½" x 11" size paper;

(2)	Showing the approximate water's edge;

(3)	Showing the location of shoreline vegetation, if any;

(4)	Showing the location of the existing structures and proposed structures, if any;

(5)	Showing the applicant's upland parcel property lines, if property to be leased abuts on property which is outside the public trust;

(6)	Showing the primary navigation channels or direction to the center of the affected waterbody; and

(7)	Including a legal description of area to be leased.

10.	LIST ALL APPROVALS OR CERTIFICATIONS RECEIVED OR APPLIED FOR FROM FEDERAL, STATE OR LOCAL AGENCIES FOR ANY STRUCTURES, CONSTRUCTION, OR OTHER ACTIVITIES DESCRIBED IN THIS APPLICATION.

   		         TYPE	   APPLICATION	  APPROVAL
AGENCY                          APPROVAL      NUMBER       DATE  

U.S. Army Corps of Engineers	  ________   ___________   ________

Dept. of Marine Resources      ________   ___________   ________

MDEQ, Office of Pollution Control________   ___________   _______

City/County                     ________   ___________   ________

Other                           ________   ___________   ________

Explanation, if applicable:     _________________________________

                                     _________________________________

NOTE:  ANY OF THE APPROVALS OBTAINED MUST BE SUBMITTED AS AN ATTACHMENT TO THIS APPLICATION ALONG WITH DETAILED PLAN OR PLOT OF LEASED AREAS, VICINITY MAPS, OWNERSHIP MAPS, STRUCTURAL PLANS OR CONSTRUCTION BLUEPRINTS.

11.	ATTACH SATISFACTORY EVIDENCE OF OCCUPANCY AND PAYMENT OF TAXES BY THE APPLICANT AND/OR HIS PREDECESSOR IN INTEREST PRIOR TO JULY 1, 1973, IF APPLICABLE, OR A STATEMENT ACKNOWLEDGING OCCUPANCY OF THE PROPERTY COMMENCED ON OR AFTER JULY 1, 1973.

12.	TERM OF LEASE:

Request the lease be granted for ________ years with the option to renew for _________ years upon expiration of the primary term.

13.	PUBLIC ACCESS

┌───┐                 ┌───┐
     │   │ ALLOWED         │   │ NOT ALLOWED
     └───┘                 └───┘

If public access is allowed, please describe extent of available public access and all barriers or hindrances thereto.  __________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

If public access is not allowed, please state reasons for restriction.  ___________________________________________________

_________________________________________________________________

_________________________________________________________________

If the facility includes a marina, will at least 50% of berths be available for use by members of the general public at the same rates charged other customers and/or members?

Yes  (___)   No (___)

14.	SIGNATURE AND CERTIFICATION:

All statements contained above and attached exhibits are true and correct to the best of my knowledge and belief.  I agree to provide any additional data or information which may be required or requested by the Secretary of State's Office.

I enclose a non-refundable application processing fee in the amount of:

(___)  $50.00 for single family residential use

(___)  $150.00 for all other uses

______________________________________      _____________________
Signature of Applicant or Agent             Date

______________________________________
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