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<br />.I.'Ji .L'" t1'l . .1.0;" I
<br />10.12.84.
<br />
<br />U-j .L.j;j.j\.l\.ll,l-l;>
<br />01 : 04:P1'.1
<br />
<br />Alij ~LLCl"ll 1~l
<br />HINSON BLO CORP
<br />
<br />i(!J i)i)2 /1)O;}
<br />;po 0 2,
<br />
<br />. .' .
<br />. .- "'.' ~..........:.-.._-".,'_....._...-
<br />
<br />, , CONDI'rIOHS OF PBRHIT APFIDAVIT
<br />> j:!,~uS;~ ":;~~t ':~~T"~~'1Ct to 'W rul:rlcila. UIa IIlf 110 .... ratrlCU.. IUa cnl
<br />">W~"regwtlCIIII. De lIIIllerallllllll! -.. f88jICIIIIJbllltp for a.'ll.... dill ~ oppJJcabIa doIIIlIIbfot.faal. . .
<br />B. LI s c RAf;rORS Alf1) CO RA fOR RESPQJfS!'B%LITIBS
<br />If tlIo...or lu h1ritl · CIlIItraefDr or """u'C!Drlr to -tab -. till, .., 1lI ngWaa tii 11......11 ......v..w willi
<br />.tata omllooaJ regulatl.... If tlt CIlIItrilotor I. Illlt I.IcelIIId u ~ Ill' 111I, iIotll ta -1lIIl1lllllictar III 110
<br />rlte4 for · .1t4"""1Mr vlol.a.. UDder .tota I... 11 tIl8 _ or IallDdad ....tmtar ila IIICtIIa IIlD Ual: 11C111tI~
<br />nqglr_ .., 8jlJI11 for tlIe iDWl4114 1OIrt, they ar'drliod to Clllltll:t.U. Clll of kp/IJtUlIt IIIlldq 1IQutIat. (tiS)
<br />7BS-56I1.
<br />
<br />
<br />hr!llorIon. If tlIe ..... hu llted I CIlIIlm:tor or cootroob!n. lit II Illrlalll to 11m tilt ClIItraclor(.) .Ip portI4If at th.
<br />'CllIItrilotar tIct!aaa~ of W. OllPllCltlCll lor IIllilI tkr Ili!I H fIQIlllaW.. If".,.. th _ lira U IQ ....tnrIm:.
<br />JOU ... lOIHcatlog lllat JUU. ratbr IUa t/II eonl:racw. Ita ~, for IIla 1lIltI;. U t11ll111Dtractar tddq JlIIl III alllII
<br />If CllI1tmlm: that IIlfIlll aJlllIIIicatl.. tllat lit I. oot properJy U_lIlllIII IlIIt 811t1tJa4lD PIIIIlllig fP~ lll1la
<br />eft, of !epllp:blIIi. . . '
<br />c. .TMHSPORTATIOH' IMPACT PEES AND trrILITY C~ION ~S
<br />D. PJNS'1'RlIaJ:ON LIEN LA!!! (CIIAP'l"EIl 713. FLORIDA ll'l'A'1'lITBs r AS AIIBIIDRD I
<br />1 cert.tfJ ~, I, tilt IIppl1eut, .n been ~ 1f.ltll e4n ol"lmil2i'. Cmltnet1111 JdID La . ...,...r. Protactilll1
<br />Guidi' 'dpared br the IJodda Departlent or 19r!lN1we and CoanIer lfflira. If tJie appUcut 11 JaIel:Iaa ok the f:ba
<br />'mer', I eertJ.f1 that 1 baye obtained is COpI of the aboot dBlCl'ibed doCatoat an4 lImdJI 1a QIII4 fl1t1l to dl11'lr It to the
<br />'lM1ar1 liner to ~CfIIIel1t4
<br />
<br />
<br />B. C~C'l'oa I SJOWNER I S AFF1DAvtr .
<br />I CIrt1ty that III tbo 1DfOrMtioa i~ thill{lPl1eatloa 11 ICClll'ate and that all "Drk I11J be 40aa In ~lllDce 11th all
<br />appI1cabl. lawa regulatIng CQUtnzct1oo, Jan1ng, and IIlJd dlle.loPRDt..
<br />.Ap~Hr.at.lon is bwbr lIIl!e m obtain a gmlt. to do NOellD4 .lcataUot!on II 1D41c.atelf. I cartifr t!lat dO vort, at
<br />JutallatiQl1 baa cc.encad prior to ia.Iuantt of II PtQit iUld that illlOrt r1Il be PBtlotled to lilt 1t.aDdarU oll11lawa
<br />tegu,lating conatrtJctJOft, CIty cod", aoa1ng regu1ationa, zmd Jal),t dar~ regula.tlGallA tba iudsticU.. I a1eo
<br />certify tblt t lWImtaM tJzat tk r~aUGDS DE ot!ler go~tll agec1q IalapplJ to tba iDtIDaed ~, aDd Uat: it II
<br />If RIlllOlllJbUit., to 14&oUfr ldIat acUQWJ I IUIt tUa to be 1a COIplWlca. Such 19lUdu Illd" bat In aot .lJt1t14 to:
<br />· ~attllmt ollnYiroll.llmtd BewleUOl1 - CiPreu Bafbads, ~ot1u<< Anas aacllDrirouatalb ,..iUn 1GdI,
<br />_tu/lastewatar fnablll~
<br />· ~llt!Iwqt llodda w~= XanaqllJle.11t Diltrict ... Walla, tnna. 1II1beodl, IiltllD4 WI, Altering Watarccucaa
<br />t W ~rD8 of~lI1dn~~ . S.~alli, Docb, lafigabl. Watuo18
<br />· DeDattleDt Df B.ea1th I Rehabilitati'e Buvicq, BufUva.ntil bll'tb [JnlJ. Willi. Wlltbatlr ~tllDt, SapUc r_
<br />· 118 In'~tal PtatBct10n .CY - I8beatc. ahatBleDt . I
<br />I also CIrtlfJ that, if Ulllatertal1a to De used 1D. flood Igae 'II or 1.,Ite.', 1t 11 UDduttuad tblt I dtabaqa plan
<br />llddruttD9' a '~W91ol_' rill be sw.1tted tlticb 1& PI'BpUId bJ a proftldGDll eagbaar registend 11 tbI State of
<br />Florida prior to peni~ wmcs.
<br />A pmJt lomd IilaIl be -trued to IlIl . 11..... to Prar:ud IIIth tlie 110ft Illlllllt II i1Ithor!tJ to ,.IoJW, CIlIct1l1tor. or
<br />set aside lilY ptoriaiona of the tech.aJca1 codu, not 1ha11 iaauanct of a puait prevent the Bu.i1&g OffidallrGl thereafter
<br />requWng I cmrectian of error, m plw, conat:r:nctioa, or YiuJatJons of IDJ cede. .I'I1I7 puait JIIV8fJ aba11 ... .tDI.Ud
<br />unIe.. the trOd lutbcd.14 b1 8Uell pmlt is ~ced within sLr IGlthI of 1uuace, 01' Jf 1m'1"riled ., * PUI1t f.
<br />'U8perJded or ibedOnll4 lot I period at a.tz alba altar the tile tile -=1 JJ =-aced. Gat 80 da1 lltau100 of tile, II, .bt
<br />allCli04 for tJlo ptCait with EM cbarga of t15.ao. flit atllUiOIS sha11 ba nquuta4 1lI11rltiGg to tile 1U!1a11g Off1c1&1. .In
<br />approved wpeat,{oc lUSt be 1~ !JgriIIi sad! siz atb Pit1olS, 0: tbe projlct will be Mfttlf"lrtd I~.
<br />VAIIIIrG to oms; TOOl FJILURB to .RICCRD ! lroUC! OF ctIIHDC!JIIR! lilY USULf II RXII 'IrlG Iller fOI ..~ 10 lOUR
<br />PJlWIDrr I IF YOU ImIfD 2'0 OBJm FI.IDCUG, alIBULf VIm YOUR LUIIBR 01111 IlallDDQ _ JUrICI 0'
<br />fDO!IIC!Ha!. JC18 UXDD *3,500 II YAWl 00 ~ BID 10 IICO<<D UD POSt lllJOrla or I.
<br />
<br />~
<br />
<br />
<br />- SIGU21JRl: IIID os AGD!
<br />
<br />
<br />BfllI ap FUIimI
<br />coom OF
<br />The foreg01Dg 1Detrument was acknowledged
<br />bofore 118 this , 19 by
<br />-
<br />
<br />ST.UI or PUIlDl
<br />axrnr or Pinellas
<br />The fcrogoiJlg iDstnent was acmaw18dged
<br />befoJ:.'8 se this 10-12 _, 19 ,94 by ',_::" ., ...
<br />~.. "'- ..
<br />',- ,. ~ -.
<br />John R. Kavula ' , . '" .....:
<br />who "'1s perSODally blOiii to IDe or ldio. ~ .. _::.:~':'
<br />produce4 na
<br />as 1deatif1cat1OA &ad who did/did Dot
<br />~tate IQ 04th.
<br />
<br />;.;
<br />,~
<br />., I
<br />.~ . "".. "I
<br />" ~"'" I
<br />';'~ '"' I
<br />....-~. .
<br />. I
<br />!
<br />
<br />who is peracmall,' inOWn to JaG oZ' who has
<br />ptoducec1 _
<br />as idcu:ltificatioll zmd who did/did not
<br />tat4 an oath.
<br />
<br />-
<br />(Siguatura)
<br />(H.,. T1Ped; Printed or Stamped)
<br />HOfARY PUBLIC
<br />
<br />
<br />,I,{
<br />I
<br />I
<br />
<br />Me!.! SA TREM2:LAY
<br />State of Floric3
<br />My Comm. Exp, Dec_ 23, 1994
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