Architectural Control Committee Heritage Hills 3195 Heritage Hills Blvd. Clermont, Florida PH: Fax Community Name: Heritage Hills Property Owner: ____________________________________________________________ Homesite: __________________________________________________________________ Home Address:______________________________________________________________ ___________________________________________________________________________ Home Telephone Number: ________________________________________ E: Address:______________________________ Information About the Architectural Change You Are Seeking Mark One o Landscape Change o Driveway (Pavers or Painting) o Electrical / Lighting o Satellite Dish o Roof Replacement o Hurricane Shutters o Screen / Patio Enclosure o Patio / Deck Installation o Other (Specify) ___________________________________________________________ Please describe the type of change you are seeking approval for. Please specify any materials to be used and colors involved. _________________________________________ _________________________________________ _________________________________________ Revised 11/26/09 Page 1 of 2

ATTACH THE FOLLOWING TO YOUR REQUEST  Copy of your property survey, marking the area where the work will be performed on your home-site.  Contractor’s License & Certificate of Insurance.  Copy of Contractor’s Contract.  Common Area Security Deposit (If Applicable – Call for Information). PLEASE READ AND SIGN THE FOLLOWING ACKNOWLEDGEMENT ∙∙∙∙∙∙ Date Received: ______________________Control Number:_____________________ Date Sent to ACC: ___________________Disposition: APPROVED DENIED CONDITIONS IMPOSED: _____________________________________________________________________________________ _____________________________________________________________________________________ SIGNATURE OF ACC: _____________________________________DATE:__________________________ DISPOSITION LETTER SENT TO APPLICANT: __________________________BY:___________________ Architectural Change Request - Revised 11/26/09  ONLY the owner of the subject property may make application for alteration or change.  Application DOES NOT guarantee approval. Any approval must be received in writing prior to marking the alteration sought in this application.  Architectural Change Approval is based upon the aesthetics of the proposed change and does not certify the construction worthiness or structural integrity of the change proposed.  Applicants are SOLELY responsible for calling the appropriate utilities BEFORE digging to have all underground services marked. Applicants are SOLELY responsible for any damage or costs associated with restoring service. Applicants are SOLELY responsible for damaged irrigation.  Applicants are SOLELY responsible for following all building codes, obtaining permits and adhering to set-back requirements when making the change.  Applicants MAY NOT deviate in any manner from the plan, once / if approved. Any change will require PRIOR WRITTEN approval. Signature of Property Owner: __________________________________Date:___________________ ASSOCIATION USE ONLY No later than sixty (60) days after receipt of all information required by the ACC for final review, the ACC shall approve or deny the application in writing. The ACC shall have the right to refuse to approve any plans and specifications which are not suitable or desirable, in the ACC’s sole discretion, for the aesthetic or any other reasons or to impose qualifications and conditions thereon. In approving or disapproving such plans and specifications, the ACC shall consider the suitability of the proposed improvements, the materials of which the improvements are to be built, the site upon which the improvements are proposed to be erected, the harmony thereof with the surrounding area and the effect thereof on adjacent or neighboring property. In the event the ACC fails to respond within said sixty (60) day period, the plans and specifications shall be deemed disapproved by the ACC. Page 2 of 2