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<br />CONDITIONS OF PERMIT AFFIDAVIT
<br />A. Nona OF DBED RB8'1'RICTION8
<br />rbe IlIldenJ,.. Illl!entaDl1l tllat tIlle pmlt .r be l.jllCt to "deed ruttlcU.... wbJeIl ., bllOr. ratrlct1" tMa cltr
<br />revul,UllIII. ftt ...1_ __ r"pclIIIibllJtr for ClIIplll11Cl! IIJtJllD' Ippllcalll. '11C1 ruttlcUCIIII. .
<br />
<br />B. UNLl~8EP CON1'RACTORS AND CONTRACTOR RESPOHSIBILITIBS
<br />If tile OIIlIer 11M Un4 . llllIItllttor or contraetore to Ulldlruq 1IlIt., tiler ., be rll\lulrt/l to III UctUIl1lo accoMcl .ltJI
<br />Itltl IIlI1local ngulaUIIU. If till contrlctor Je DOt 1IC8Mlt II rll\Jlllrll1 &r 111I, bo~ tH .. .. ..tnctAlt IIJ be
<br />eltll1 for I .l~ dolatlon \IId.r .tate ta,. U tile 0IIIlIr or IntfJIWllllIItrector ue lIlIc:er:talD .. to eat U~J",
<br />requlr_UIIJ 1IIP1r for the Inttaclecllllr., tiler art lll'tlec1 to tlIDtlCt tbt Citr of Ilpbrt~UlI IuJldlag ~t, llU)
<br />788-6611.
<br />
<br />Furtllmore, If till 0lIllU IIu IIlr111 . coatr.ctor or coatr~OIl, be II 14'11" to IIlfe tilt ClOIltrlctor(.) .111I port1gat of tIJe
<br />'CoatrlCtol' 8ecU.' of WI IIpplie.tlOll for _Jell tiler .m be rtIpclIIIlble. 1f)'OU, II tile .. "'P II tM _UlCtor,
<br />rou are JaaJeetlag tlltt JOU, rltllllr tbIn tile coatr.clor, m rllpOllllble for tile IOtt. If Ut CODtrector w1lllet JOU to .Iga
<br />ae ClllItractor tW -, be III Indlcatlllll tllat ~ 11 DOt properlr UctDlllllIId II IIOt IIIt1UIl1 to pualt,tJIg ,d,n... III tIIll
<br />Cltr of Iep/lrrllUl... . - .
<br />
<br />C. TRAHSPORTATIOH IMPACT FIBS AND UTILITY COHNBCTIOH P1Ul:S
<br />
<br />D. CON!'1'RUCTION LID LAW CCHAPTBR 713, FLORIDA STATUTU, AS AHBIDBD)
<br />1 cutUr u.t I, till tppliClllt, 11m lIMa prodded ,ltII I tIlPJ of "rlorJ4a'1 COlIItruCUClII 1.111 Law w ....'. Protec:tlllll
<br />Guide' preptr8l1 br tIIll 'Iorlda Departllat of Agriculture llIld Conauer Iff,I". If tIIllepplleat II .... otlllr tiu tile
<br />'owoar', 1 certlfr tIIIt I be,. obt.IDIll I ClIpJ of till aboyt _dbe. doc:uIeDt IlII1 prem.. ID _ f"~ to WI,.. It to tbe
<br />'Dllner' prior to ~t.
<br />
<br />E. COlf'lRACTOR' 8/OWlfBR' S AFFIDAVIT
<br />I certu, tIlIt alJ tM illfonatlClll 10 ~ll appUcatlon II &ceIltltt IDd tbat all lIIIrt 11m be .. la ClIIpJllllllt IIltb IU
<br />appUcaIIl1 111I ngalltlD9 ClIIIlncUlII, lOllIng, IIllIIIDCJ lItY8.le.-nt.
<br />
<br />AppUClUoa II IIIrUr .. to obtalo . pmit to 110 IIOrt .. IneWI,Uou .. latJIClt... I ctrUfr tat 110 IIOrk or
<br />loauU.UOIl .. ___ prior to IQ1lIlICe 01 . perIIlt ., tat allllllt. 11111 be perf 001I1 to _t ItIIaIrfI of .11 I..
<br />teVlIllting ClIIItnctlCll, Cftr coda, lOllIng regullUOIII, III<< 1" l1Iytlu,..t ngallUOII ID tal JllI'latictJ.. I allO
<br />certlfr tat 1 Wll1araWd tIlat tbe rlgllllUlIlII of other ",....tal aveac.I- ., awlr to u. 1Ite.W .n, IIIl1 tat It II
<br />If rUpollIllllUtr to I_tlfr lIUt lellOll8 IlUIIt WI to be In COIplllDCe. 811d1l1pDClu lDClul1lllat an lOt IIl1l1l1 to:
<br />, Departllllt of IDYI~talll!lulat1Ol1 - Cypr... hrblac1l, IItUIll4 Ire.. alii! InYlrOlllllltall, IUIIU" Le.a4t,
<br />Watar/Klltellatu trllttut
<br />· 8ouu...t 'lorlda later :t Olltrlct - ...111, CypCIII II,..., ..tllllc! Irlll, Ilterlng IIttercour_
<br />· AIIY COrp of ....,. . 8IM1 I, Docl" 1a,lgtbl. IIttltH"
<br />· IlIDutBt of ....g. .....l1ItlUft Banlcea, 1D,Ir_tal1II1t11lilt w "UI, IIaItllltIr !reet.t, IlpUc I.
<br />· 1II111Y~ S- ....taI ablu.t
<br />I 1110 c:utI , , I fllllltlr I. to be _ I, rllllllllolle ".' Or '.,.tc.', It 1. ua/ltretoocl tAt . tt..... ,lID
<br />,adrllllag I "alIII*IIIt!Dg tOl..' 1m be .uIlIltttd .bidll. prepull1 br I profenllllla1 ..IDler regl.teh.1 Ii tM ltatl of
<br />Flodd. prior to perllt l..llIICI.
<br />
<br />I pmlt I...... .11 be llOlIItnec1 to be I lfCIDIII to proceed , It II tallOlk ead IIOt II lutlaodt, to dol.ta, CIIICIIllw, or
<br />..t .dele IIIf prod.IOOI of till tecIlIIJcII cadll, 110I llItlJ I.., of . perIIlt pm8llt tbe IlIU41Ig Offici.. fa tberNft.r
<br />requJr1lll . corrlOtlCII of mor. 1lI pI.., CIllIIUucUIlII, or dolltlllll of III coa., lflQ palt ...... IWJ __ Jnelld
<br />unl... UlIIDr1 .tMri.1I111r .. perlin II c.mce4 ,IWD ,1111l11U1 of I...., or Jf IOrt ...r.... ., tII pmlt II _
<br />IUlpeadId or ....., for I period of III atU Iftlt UI till tM lIIIr11...... 011I'0.., ..... of till, ., be
<br />.UllIed for tM fIl1Jt 'Ill '" cbar91 of '.5.00, !be eatlalloa ..11 be flllllltltld ID 1l1t1nt to tlIIldWIt Omclll. III
<br />IpprDftl11UptCt10l1 .t be 1_ 4urlao eaell .11 ..t.b padOlt, or the pro,ect .m be COIIIlhn4 .......
<br />UIIG 10 -, !WI mLllIO .. 110111.1 0' lXIIlIIlCIIIIlllr _III _ PAflllIlIlCI . INIld 10 mil
<br />PIlOI'II!Y. I'. IftIIO YO OIUII PIIIICIIG, ~r IIID lOll..... 1Il1lllmlllllllPOlll aaIDUG fa 1OI1C1 01
<br />aJIIIDCIIIIl!. __.2,500 I. YAWl 00 IIO! DID 10 ..lID fOS! l 'IlrrlCl OF 1DIIlIIIlmIt'.
<br />
<br />SIGU~ IIlII!
<br />
<br />
<br />nAIl or MIlK
<br />coom or
<br />Th, fOllllolag iD.tZlDtllt II" ~OWledgtd
<br />before .. tbie .1'/t_l;; t 19 by
<br />
<br />
<br />IIbo 1. ~cI'Ul b~ to .. or ..hO bat
<br />produced
<br />.. ldat1f1caU. ODd who didl II D t
<br />tllte oath.
<br />
<br />BIQII7lIIIIC~~
<br />
<br />Ifln 01' fUlIN
<br />coum or
<br />Tbe foregoiag 1JI8tr~~ .... Ie
<br />before _. this _~, 19
<br />
<br />1ldged
<br />by
<br />
<br />
<br />.bo 11 ~~ to .. or who bii
<br />produced
<br />II ldaatlf1cltioo aad wbo dldi Id t
<br />take o.tb.
<br />
<br />/'
<br />
<br />~1A,p
<br />..... .",.
<br />~....
<br />
<br />.....~ 1 A..s>.",.
<br />~\.\....
<br />
<br />JAMES F. NICOLETTa
<br />'ltt. .t florid.
<br />COlIlll,,,,OI No. t CC050283
<br />lIy Cllllltli. (xp. Sf_I. 24, 1994
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