HomeMy WebLinkAbout16-17142 CITY OF ZEPHYRHILLS
5335-8TH STREET
' ' (sis)�so-oo20 17142
FENCE PERMIT
PERMIT INFORMATION LOCATION INFORMATION •
Permit Number: 17142 Address: 38017 OLD 5TH AVE
Permit Type: FENCE ZEPHYRHILLS, FL.
Class of Work: FENCE/NEW Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 11-26-21-0010-15900-0130
Improv. Cost: 1,000.00 OWNER INFORMATION
Date Issued: 3/09/2016 Name: TURNER, NIGEL
Total Fees: 45.00 Address: 38017 OLD 5TH AVE
Amount Paid: 45.00 ZEPHYRHILLS, FL. 33542
Date Paid: 3/09/2016 Phone: 863-255-0843
Work Desc: PRIVACY FENCE 174 X 6FT
CONTRACTOR S APPLICATION FEES
HOMEOWNER FENCE 45.00
,/ _
�
� ° Ins ections Re uired
FINAL
REINSPECTION FEES:(c)With respect to Reinspection fees will comply with Florida Statute 553.80 (2)(c)the
local government shall impose a fee of four times the amount of the fee imposed for the initial inspection or
first reinspection,whichever is greater,for each such subsequent reinspection.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that
may be found in the public records of this county, and there may be additional permits required from other governmental
entities such as water management, state agencies or federal agencies.
The payment of inspection fees shall be made before any further permits will be issued to the person owning same
"Warning to owner: Your failure to record a notice of commencement may result in your paying twice for
improvements to your property. If you intend to obtain financing,consult with your lender or an attorney
before recording your notice of commencement."
Complete Plans, Specifications and Fee Must Accompany Application.
All work shall be pertormed in accordance with City Codes and Ordinances
-d'v.�- .�,
CONTRACTOR PERMIT OFFI
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTIO
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
813aso-oo2o City of Zephyrhills Permit Applica#ion Fax-813-780-0021
Buitding Department
. DateRecelved � �.��j phone-ContactfarPsrmi#tin �� �� ����
r �
Owner's Nartee � i'il,�{' Owner Phone Number �2� 2-�J � �S,
4wner's Address c}�n(� ��� �1'' �t/Z- Owner Phone Number ��3 '��!) �Z-�� �
Fee Slmple Tltleholder.Name ��t1°,���!". � �'I'"I�C._�QJ►Ui�I Owner Phone Number �- ��
T
Fee Stmple Titieholder Address �� I�'1 �1 Jfi �.¢ � �(, 33 J��'
JOB ADDRESS � 0 b I 1 �I� f,)�� I�4 �C. �3 c���""��2 LOT# [�,�
SUBDIVISION �� � P10.RCEL ID#
(OSTAINEp PROM PROPERTY TAX NQTiCE)
WORK PROPQSED �NEW CONSTA ADD/ALT � SIGN Q CJ DEMOLISH
� INSTALL e REPAIR
PROPOSED.USE _ Q SFR Q COMM Q OTHER
TYPE QF CONSTRUCTION , Q BLOCK � [�� FRAME � STEEL Q
a
QESCRIPTION OF WORK 'cl � �e��-e- �� M/► �'�� �9 `�`� ��S�l
BUILDING SIZE � � SQ FOOTAGE�,�„�. HEIGHT C��
BUIL,DING $ � `--� 4''�•"�", '-'_,�
, ��.��� VALUA710N QF TOTAI.CONSTRUCTION
L_..�
QELECTRICAL � � AMP SERVICE Q PRQGRESS ENERGY [� W.R.E.C.
o���MB��� � � -���7j�z
QMECNANlCAi. $ VALUATlON OF MECHIWICAt.lRtSi'ALLATION
OGAS � ROOFiN{^a Q SPECIAtiTY � t3THER
FINISHED FLOOR ELEVATIONS ��� FLOOD ZQNE AREA [�YES NO
BUILDER /� r��;,�"='��~ COMPANY C/�---
SIGNATURE � REGISTERED Y N FEE CURRE� .Y/N ..
Address License# r� � �
ELECYRICiAN � COMPANY
SIGNATURE REGISTERED Y J N FEECURRE� Y/N
Address �� License# � �
PLUMBER - � COMPANY
51GNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License# � �
MECHANiCAI. COMPANY
SIGNA7URE REGISTERED Y./ N FEE CURRE�- ' Y/N
Address License# I �
OTHER COMPAFiY
SIGNA7URE REGIS7ERED Y/ N . �FEE CURRE� , Y-/N.
Address ' - ' Ucense# � ��
RESlDENTIAt. Attach{2)Ptot P.lans;.(2}sets afBuilding Pians;(1}set o1 Energy�Forms;R 0=W Perrtiit far_new constructf,on,
Minimum.ten,(1.0)working;tlays afiter.submittal dete. Required onsite,ConstivoHon Plans;°Stormwater Plans w/Silt Fence tnstalled,
Santtacy Facilities.&�1;dumpster,.31te Work�Rermit tor,"subiifvis[onsllarge projects -
COMMEiiC1AL Attach(3}c;ompfete sets�of 8uildirig Pians plus a Cife Safety Page;(1}set of Energy Fornns.R-Q-W Permit for new canstruction.
Minimum ten(10)wo�lcing days after submittal date. Requtred onstte,CanstrucUon Plans,Stormwater Plans w/Silt Fence installed,
SaniGary Fec3litles&1 dumpsier.Sfte Wcric Permit for ail nei�r'projacts.Alt commercEal.requirements must meet compllance
SIGN PERMIT Attach(2)sets of Engineered°Rlans:. :
"""PROPERTY SURVEY requir�cl for all NEW canstructton.
Directions: "
FIII out application completely.
Owner 8�Contractor sign back of applica�on,notatiz�i
If aver 52500,a Notice of Commencement(s requlred. (A!C upgrades over S750d) � , ---• - . �-• ��
'" Rgent(for ttie contraafot}or Pbwer of Attamey.(far the owmerj'woutd be.someone with natarized letter frdm owner authorizfng same ' ;
DVER THE COUNTER PERMITTING (Front of Application Only) � ' �
Reroofs If shingles Sewers Service Upgrades WC Fences;(PIoUSurvey/Footage) ' ,
Driveways-Not over Counter if an public roadways..needs ROW
I
Nt}310E OF.DEED RESTRICTIt?NS. The undersigned a�nder�tands°;Eh�t#hls:p�rmii=�.may.bersubJect,to,"cfeed",res#rlctions"
whlch may::be�more,r.est�icttve�than Caunty:regulatfons.'TFie�und"e�signed`�assumes.responsitiilt'ly�for compliance'witli'"any
applicable.deed restcictions. �
UN�iCENSED:CONTRACTORS AND CONTRACTOR RESPONSIBILITIES:� �i#ttie owner has-�hired a cantracfor or
contractors to undertake work, they may.be:cequtred=;to.;b�<Itcensed in accardance.with state.and•local regulations. -If�the
contractor„Is:not:lfcensed as requlred'by law� botti the owner and contfactar-may be-clted-for amEsdemeanar ulotation
under state law. if the owner or Intended�,contractor��are;uncertain as to what iicensing.requlrements;may.apply:N�for�the �
(ntended work, they are advlsed to�contact ttie Pasco County Bulld}ng (nspection L11vlslon-Ltaensing Seotlon at 727-847-
8009. Fu�thermare, tf the-awner tias-hiTed a contractor`or cantractars, he is advised to have the contractor(s), sign
portlons of the "contrector Block" of-thls application for.which they v�rill_be r.esponsible. Ifyouu,.as-.the owner`slgn�as the
contrac#or, tfiat�may�be�ari fridicat#an that�he ts no#.praperiy ticensed and�Is noY entiNed fo permitting privlleges in Pasco
County. - . � ;
TRANSPORTATION�lMPACTIU7ILITIES(MPAC�'�ANb RE30URCE I�ECfJ�ERY•FEES: The underslgned understands €
that Transportation Irrtpact Fees and.Reco.urse Recove.ry.Fees may�;appty-ta�the canstruc#ion af new buildings,;change=of ;
use in existing buildings;�or,expansion�.of`eiiistin�g��6uiltlings, as specifled.in Pascq�County Ordi�ance number 89-07 and �
90-07, as amended. .The undecsigned atso:understands, th�t�such fees,.as,may_be�due�;wlll�:�e identified at tt►e��tirrie of ,
permitting. It Is iu'rtfier understoad that Transpo�katlon IMpact Fees and�Resource Reaa�ery��Fees.must be paid prtor to �
rece�ving a°certiflcate..of;occupancy" or finat-pawer�release. :If the pro�ect does.not tnvoivesa:.certtf�cat's of occupancy.or - t
final power-release;:the�fees mu�t•be paid prior ta permi# Issuance. Ft��Ehermore;�N.Pasco County Water/Sewer�lmpact � �
fees are due,_they.must.be�pald.prlor to permit�lssuance-In accordance with appllcable Pascv�County oidlnances. �
CONSTRUCTION-LIEN�I.AYII{Chapter T13,Fla�da Statutes,as amend�d); If vaivatlon of work is$2,500.00 ar more�, 1
certify that I, the applicant, ha�ve-been provided with a copy� of #he "Flarida Construction Lien' Lav�—Homeowner's
Protectlan Guide" prepared by the Fiorida Depa�tment of Agrfc.ulture and CansumerAtfairs. If#he appllcant ts someone
other than the"owne�', I certify that I h�ve.obtalned�a-.copy of the:above.descritied docuiri�ent°and.p.r.omise in,goqd faith�to
deliver It to the bwner".priar=to�commencement: � ' � ,
CONTRACT{�R'SIOWNER'S AFflDAVIT: 1 ce�tify that ail.the,{nformation.infthis applicatian is accurate and tha#atl wark
will'be done in compliance wfth all appl(cable laws regulating constructton, zoning and:land�development. Appltcation is
hereby made to obtaln .a perm€t to da. wor"k..and Installatlon as !nd[cafed:�;. °I certify #hat no wark=or tnstalla#ton has
cammenced prior ta Issuance of a permtt and that.all wark will be pertormed to meet standards of ail laws regulaxing-
canstnaatlort, Counky and Gity codes, zoning regulatinns� and land development regulatians�En the jurisdiction. 1 a1'so
certify that 1 uaders#and thaf the reguia#ions af other government agencies may�apply�to the intended work, and that it is
my responsibility ta ident6fy•whak.actfons I must take to be,In:.corrlpliance._Such agenctes include but-are.not Dmited to: :
- Depactment af Er�vironmental Pratec#ion-{;ypress.Bayheads; VNetland Areas and Environmentatty Sensitive ;
Lands,WaterNVastewater Treatment. �,
- Southwest Fiorida Water Management .DisUlc#-Wells, Gypress.,Bayheads; We#land Areas� Alter3ng �
Watercourses. °
- Army Corps af Engtneers-Seawalls} Docks,Navigable Waterways. ?`
- Department of Heal#h�`8 ReF�abllitati�re SenrtoeslEnvironmen#al Heatth Unit V1►eifs, Vllastewater Treatment,
Septic Tanks: _ -
- US Enviranmental Protectton Agency-Asbestos abatement.
- Federal Avlatlon:Authority-Runways.
1 understand that the following:restrleNons apply ta the use of flIL�
- tlse af fi{i is not allowed in Fload Zone�VV"unless expressty permitted.
- If the fiil materfal 1s to be used. in. Flood Zone. °A", It. Is understood that�a drainage plan addresstng a
�compensaEing volume"wiil be submltted at time of permitting wh�ch Is prepared by a professianal engineer. _
licensed�by�#he-State-of�Flarida:
- 1#the fiil materia#�is-to be used fn Flood Zone "A" !n�conneation=wlth.a permitted buiiding using stem waN
canstructio�, I certifiy that fiil:wall�b.e used only.to fiti the area withtn the�s#em�walt. , ,
- If fill matertal is to��qe used fn any area, I certify that .use. of,suchi"fil! wiA not adversely affect adjacent
properties. #f use of fltl is#ountF to advetsety,�ffect ad�a�ent�properties,.the awner rrtay be ci#ed for violating
the conditions af the'building:permit Issued•under the attached permit applicatfon, for lats less than one (1) '
acr�a whtch are elevated�by flli,a�t engineer�ed dralnage ptan€s regulreci. .
if 1 am the AGENT FOR THE O'iMNER,° I4�promise in good faith#a inform the•awnerof�the permitting.condit(ons set forth In '�
this affidavit-pr#or to aommencing constructlon. 7 unde[s#and that ars�parate permit may be requtred for elect�ical work, ��
plutnbing, signs, wells, paots; air conditloning, .g$s, o�o#hec instaliations not.spea�ically included in #he appiication. •A , •
pe�mit Issued`shall be consttued to be°a'�Iicense to p�oceed with the'work and not as�authortty to.vialate,cancel, alte�, ar
set aslde any pcovfsions of the#echnfcal.codes;�nor shall issuance$af a pecmit.prevent the Bulldl�ig C?#ftc[af from the�ea#ter
requir(ng a carrectfon nf errors ln plans, consfruction or vlola�ons of any codes:. Every pemtit(ssued shail become invalid ;
unless the work authorized.by such perm(t-�Is-commenced�wtth(n sl�c�nonths of permit issuance� or !F wark authorized by �'
the permlt is suspended or.�bandoned far.a:period,of:six(8)mantfis.:after'the time tfie�work is commenced..An extension ��
may be requested, tn wrlting, fram the Building,Officfal for a period.not to exceed'Nnety�(90) days and will�demonstrate i�
�usti�able cause for.the extensian. If worlc ceases:for nlnety{90)cons.ecutive daysr_#h�jab-is.conslde�ed aba�doned.'� #;
,. (;
WARNING TQ OWNfR: YQUR.FAIl:URE�TU�R�C:O�tCl,A-:Nt3TIGE�QF�COMM�NGEMEN'� MAY�RESC!!.T IN YflllR ;;
PAYiNG TWiCE.FOR iMPROVEMENT3 TO XOUR.;PROPER'f,Y. :IF�YOU�It�TEND�'T��iJBTAiN�•F1N�ANCING;�CONSUL.7
WI7H�UUR.LEND�R:OR AN A�'TORNEY B�FO�E�,R�GAR�IWG:YOUR�NATICE'OF C�OA.;�ENCEINENT: _ �.
FLORIDA JURA�'{F.S:1'lT.03} � — -- - —-
� �_�,,,/ n
DWNER OR A�EN � z _ R"�~ . _ CONTRACTORT� �I��„�.
3u scribed and swo to{o anad}beiore me thts Subactlt�ed' nd' m- (ot aflirrrted)�before me't#il�
_„��'i 9-1 h bY I�i k c'�. I ln 2n/EY;' 3� � •� n!4„�FL i,.e;✓�2
Nho is/�e pe ana y knav� to-me or haslt�ave produced Who.ls/ pe allyknown•to me or haslhave�produced •
1%'L,. fGrl,�uGt-��B�-as tden�llcetlort. as tdenBEicaBon.
�,.
>� ' � ' blic �'�jc'"�- Notary Pubtic
:ommissi o. Q•,,,:°Y�i°,, JAC(1UE E B�G��4=� .t,�Y>'°,,,
. . Commisslon: .�o. s� �
. ::: . :
' :;: Expires December 12,2018 ="� ;�: Commission#FF C r��7
�:7 ��Q;p 'y7' :Ot` �ilO�LG
�lame ot Notety Name of Plotery ° te���t���ntasu,ansaEt'0-3@'a-)OI9
. • DISCLOSIIRE STATII�NT FOR OWN�R
CITY OF ZEPHYRHILLS BIIILDING DEPARTMENT
I, � ��Q,� �l.,l,trQ-� have read and fully uaderstand and �
agree to t�visions of this instrumeat. ,
The undersigned states and affirms that he or she is desirous of constructing,
renovatiag, addiag to or reroofiag his or her own domicile, that he or she
actually occupies, or will occupy by said domicile, aad same is not for
reat, lease or sale. That he or she shall comply with the followiag conditions:
1. That the owner and he or she aloae ahall act as the builder for all phases of
construction.
2. That the owaer will comply with all provisions of the City of Zephyrhills
ordinaaces and codes pertiaent to the building.
3. That in the event various phases of coastruction are subcoatracted, he will
engage oaly properly licensed subcoatractors and will persoaally supervise, ' '
such work.
4. That in the eveat the Buildiag Iaspector shall require correctioas to be made,
the owner will assume full responsibility to insure they are made, and upon
completioa will call for a reiaspectioa before proceediag with the building.
5. That the owaer shall assume full responsibility for the construction aad will
not expect supervision of his work from the City of Zephyrhills Building
Departmeat.
'� 6. That prior to final inspectioa any additional fees, iacluding reiaspection
fees, must be paid ia full. A written request from this office shall �
coastitute an official aotice to pay additional fees.
7. That the owner shall comply with all City, State aad Federal laws ia regard to
social security, workman's compensation, lien laws, etc. , where applicable.
8. That the owner shall comply with all the safety codes issued by the Florida
Industrial Commission.
9. State law requires constructioa to be done by licensed contractors. You have
applied for a permit uader aa exemption to that law. The exemption allows
you, as the owaer of your property, to act as your owa coatractor with certaia
restrictioas even though, you do aot have a license. You must provide direct
onsite supervision of the coastructioa yourself. You may build or improve a
oae-family or two-family residence or a farm outbuildiag. You may also build
or improve a commercial buildiag, provided your costs do aot exceed $75,000.
The buildiag or residence must be for your owa use or occupancy. It may not '
be built or substantially improved for sale or lease. If you sell or lease a �
buildiag you have built or substaatially improved yourself withia 1 year after
the coastructioa is complete, the law will presume that you built or
substaatially improved if for sale or lease, which is a violatioa of this
exemption. You may not hire an ualicensed person to act as your coatractor or
to supervise people working oa your building. It is your responsibility to
make sure that people employed by you have liceases required by state law aad I
by couaty or municipal licensing ordiaances. You may aot delegate the �
respoasibility for supervising work to a licensed coatractor who is not
liceased to perform the work being done. Any persoa working oa your buildiag �
who is not liceased must work under your direct 8upervision and must be
employed by you, which meaas that you must deduct F.I.C.A. and withholding tax
and provide workers' compensation for that employee, all as prescribed by law.
Your constructioa must comply with all applicable laws, ordiaances, building
codes, aad zoniag regulations.
, OWNER'S SIGNAT� 1 a""- DATE 3 ��� I�
ADDRESS (7
PHONE (�3 d
WITNESS PERMIT #
" SECTION II TOWNSHIP 26 SOUTH RANGE 21 EAST
suaveroR s NOTE: ' FE"`�•••"�� ZEPHYRH I LLS PASCO COUNTY. FLOR I DA
THE IS F00T WIDE ALLEY SHOWN ON RECOftD PLAT IS INCLUDED WITHIN 0�PA0 ,,.•'
THE BOUNDARIES OF THIS SURVEY. BUT IS NOT INCLUDED IN THE LEGAL DESCRIPTION:
DESCRIPTION AS PROVIDED ,.•
o q0 0� LOTS 14 AND I5. BLOCK 159. LYING NORTH OF OLD STATE ROAD 54 AND THE WEST I/2 OF
� �� LOTS I6 AND 17 AND THE WEST I/2 OF THE SOUTH I/2 OF L0T I8. ALL IN BLOCK 159.
, o �\R0e2�63o'� CITY OF ZEPHYRHILLS AS PER PLAT THEREOF RECORDED IN PLAT BOOK I. PAGE 54. PUBLIC
'� SCALE I� ' 20� RELORDS OF PASCO COUNTY. FLORIDA AND THAT PART OF SECTION II THAT LIES SOUTHWESTERLY
'' F�p�N� � OF SAID BLOCK 159 AND EAST OF OCCUPIED EAST RIGHT-OF-WAY LINE�F IST STREET AND
"� 0� NORTH OF THE NORTHER�Y OCCUPIED RIGHT-OF-WAY LINE OF OLD STATE ROAD 54. VACATED AS
'� � �12 �0 rn PER OFFICIAL RECORD BOOK 3025. PAGE 311. PUBLIC RECORDS OF PASCO COUNTY. FLORIDA
.,.• O�-( o ,.•'F'� AND FURTHER DESCRIBED AS FOLLOWS: COMMENCE AT THE POINT OF INTERSECTION OF THE
'� N 5$ � �Z�••'� � LINEPOFDSAIDTLOTIIST.BLOCKY159NFORFA POINTAOF BEG�NNINGITTHENCE SC86I55 qjSWERLY
'�� ��t,EtP� 6c�3a �E o •Y'� � ALONG THE NORTH RIGHT-OF-WAY LINE OF OLD STATE ROAD 54. 62.96 FEET: TNENCE N 45°-
wI � g ,� FE� . 2 Q/� 56'46'W.. I3.63 FEET TO A POINT ON THE SOUTHERLY EXTENSION OF THE WEST IINE OF
�I FA�P�pe � N �P�o \IZ A O�( \� l ' 33�93SFEET TO THE OCCUPIED�NORTHWESTERLYICORNER OF69HE SOUTH�I/2EOFE�OT65834BLOCK
3 �. 159: THENCE 5.24°17'25'E.. 98.08 FEET TO THE POINT OF BEOINNING. SUBJECT TO AN
..�' V�N •\ �� � EASEMENT FOR PUBLIC UTILITIES AS PER OFFICIAL RECORD BOOK 3025. PAGE 311 AND
\ � S� . -� OFFICIAL RECORD BOOK 3032. PAGE 076. PUBLIC RECORDS OF PpSCO COUNTY FLORIDA.
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0 5�p�°163 � � Z , •''��p��EN � I- THIS MAP REPRES�NTS A BOUNDARY SURVEY. (FIXED IMPROYEMENTS SHOWNI
2�o Fo .'•, �`� Zo FE �6 2- DESCRIPTION PROVIDED BY SUNSTATE TITLE AGENCY
a $ . '• . O� 3- B E A RI NGS SHOWN HEREON ARE BASED OP}ASSUMED DATUM AND REFERENCED TO
� xo s I N,' ;. p� ':. a�'c � THE NORTHERLY RIGHT-OF-V7AY LINE OF OLD STH STREET BEARING S B6°55'47'W
o zm � � ' �AY�' Q��: w 4- 7HE LAND SHOWN HEREON APPEARS TO BE LOCATED IN FLOOD ZONE '%' ACCORDING
> . �� i aD � ��q,'���•' � TO FIRM COMMUNITY PANEL N0. 12101 C 04 5 2 F D A T E D S E P T E M B E R 26. 2014
~ d � .-z :CaN�''�" 2�� O � 5- NO APPARENT SURFACE ENCROACHMENTS EXCEPT AS SHOWN HEREON.
Wo N �o I �•�.' ' � ' � `'a a��S AO'� , ••'�� �,�.E� 6- UNDERGROUND ENCROACHMENTS OR UTILITIES (IF ANY1 NOT LOCATED IN CONJUNCTION
� o � -LL �� �`'s ' :: � .o �,� �NGE o � 0 ,.•• ��pp 0 p WITH THIS SURVEY.
�— � � F � ,�o� Sq0�5�0 �Rp g�p1 �`' 7- FENCES SHOWN HEREON ARE ENI.ARGED FOR CLARITY AND MAY NOT BE TO SCALE.
(n o � m I '� �Z oN� �l R �1 ,.••• �IZ 0�' 'B- THIS SURYEY PREPARED WITHOUT THE BENEFIT OF A TITIE SEARCH.
W r-m���' �-' o 50��38� ' p� Fa�N g'E THIS SURVEYOR NOT RESPONSIBLE FOR EASEMENTS. ADDITIONAL RIGHTS-OF-WAY
� W W". . w� 'a�Z' MP N� .•'� p� �5 . OR OTHER ENCUAIBRANCES OF RECORD N0T FURNISHED TO THIS OFFICE.
f— "' p u$ldd N � � � 39� \ 65 3 9- N0T VALID Y1ITFIOUT THE SIGNATURE AND THE ORIGINAL RAISED SEAL OF A F40RIDA
� Q �NM �I � p1 � LICENSED SURYEYOR AND MAPPER. ADDITIONS OR DELETIONS TO SURVEY MAPS OR REPORTS
.� �A� •• �oa ..
� �'�""' �� PORTION OF ' oc� ••''E R°N�o� ••' \3 BY OTHER THAN THE SIGNING PARTY IS PROHIBITED
�I SECT I ON I I �'-�° P°��N"�.••'�,ot�"`N Fp����0 "' 2 �O� 10- ANY REPRODUCTIONS OR DISTRIBUTION OF THIS sURVEY MAP OR REPORT WITHOUT THE
` o �mm o EXPRESS YfRITTEN CONSENT OF SIMMONS AND BEALI, INC. IS STRICTLY PROHIBITED.
p �=az y TOWNSHIP 26S . ''' � THIS SURVEY MAP OR REPORT IS VALID ONLY TO THOSE INDIVIDUALS OR ENTITIES NAMED
��� i RAN6E 21 E :•= HEREON. SIMMONS AND BEALL. INC. AND / OR THE SIGNING PARTY ASSUMES NO
o ?" �NE,.••'�go� �q � RESPONSIBILITY TO ADDITIONAL PARTIES FOR ITS UNAUTHORIZED USE.
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