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<br />-....:-.---.' OCT-13-'94 THU 10: 12 ID:
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<br />TEL NO:
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<br />~318 P02
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<br />CONDITIONS OF PBRMIT AFFIDAVIT
<br />A. IfOI'ICB 0. DBED RBSTRICTIOJjJ
<br />!Ill ..JInj.... ........ tlaet W. penit .., be IUlJject to -dtecl1'lltdeUODI' Ibfcb .., be .. rtItr!ct1" tIIIII Clt,
<br />rlpJ.u.. lilt 1IM1trUgu4 ... l't8pCIIIIJbUtt, for COIpUace ,Ith II, appll_1. clIIc1 _tr~.
<br />
<br />B. UlfLI~BD COIft'RACTORS AND CONTRACTOR IIBfPQNSIBILITl& .
<br />If u. - MIl .-.rtlJ I -tractor or contractor. to undutiU IfOfl, L tber .., III nQUlrlll to .. U.... III ...... .iei
<br />.tate ... 1oCI1 npJatlCIIII. If th contrec:tor Je IlOt UctDlld u fltUired br 1.., IlOtJa the .. ... ..... ., .
<br />cited for llill...DOr ,Jol.Uoa under .tate I.. It tile 0IIIlIl' or lDteaded c:aatr.ctor ~ IICII'tIIA II to *t llC111I.
<br />npi~tI .., ..,lr for tJae intuded IOrk, theJ ue Idvilld to CGlStIct tbI cu, of JepbJrW1Ildla.. ~, ('U)
<br />781-6611.
<br />
<br />rurUlrlOrl, 11 ~ .. .... .lfIll . contractor or contractor., be I, IlIvtHd to 11m till COItrIctOrCI) lip portiorII of toM
<br />'CGlltllCtor ....~ of WI IppliClUCIl for -iell tMr ,UllIe tllJlCllll1ble. If rou, .. tilt .. dID II tilt ..,..,
<br />JOU U1 WlcaUag tJalt JOU, r.k tJIaD tile c:aatractor, lIe r..poulble for tile lOll. If tM ClDtnctar..... )OIl to lill
<br />II aIDtnctor tIIIt ., be u 1D4Jatloa tJalt be 1. DOt properl, llClDltd aad 11 JDt .UUIIl to PIIIltUlg Jdw11eglt la *
<br />cu, of 1IpIafd1111. _ .
<br />
<br />C. nwt8PORTATIOlf IMPACT "EBB AND U'l'.JLI'J'Y CONNBC'1'ION FBBJ
<br />
<br />D. ~'T~ION LIBN LAW (CHAPTER 713, FLORIDA 8TA'l'U'tB8, AS AIIIIIDD)
<br />1 eattfJ talt 1;tJIe appUClDt, .. been provJeW ,Ub . copy of ',lorida'. CGaltnct1011 ... r.. · ~'. PIOtIcUGI
<br />Goldt. prtpItIl1 bJ tM 'lorta Dlpartleat of agriculture a.o4 Conuer Affaln. If tba IllPUcut It _ otIIIr tMa tile
<br />...., I cerWr dlat lIlY, DbWDtd . cop, of tJJe .fa dllcdbed c10cueIt lad prGIIu iI .. fd~ to ..11. it to till
<br />'_r' prior to t)lInrlD*llt.
<br />
<br />B. ~'8(OWlfBR'SAF'IDAVIT ~
<br />I Clttir,-tiaftllli"-lafoiIitloft la lble .,pllcation i. accur.t8 mJ tblt all_rt will lie _11__ .l~ III
<br />IppUCIblI 1M ..tIIg CClIIItnetlOD, -.Ing, IDd lend dtnlop1e1t. ,
<br />
<br />1pp1lcaUalll .., .. to oIltaiD . penn to do IOrl IIId lnatallaUOD II IDdJeatlll. I cert1fr tMt 10 _1. or
<br />illlWlat1aD -- mllltDCllJ prior to 1..111DCe of . peolt and tbat IU JOlt.w .. puforlll1 to _ ..... 01111 ....
<br />reguJatlag OOIItracUoo, CUr coct.., lOlIing fegulaUOIlI, 1DC1.1aact devll.-t rlgalaUa 1D ~ Jarlttict1.. I 1110
<br />certifJ tMt I "'1. thlt tk regu1.Uou of otber per-.atll 11I.11 III applr to tha JatIIW _1, .. tut It II
<br />II rtapCllllb1Utr to ideaUf, u.t aeU. I _t tale to be la COIpUIDCt. 8ac1a 1PDC1- 1nc1_lIIt .. DOt Illlbd to:
<br />· a.rt.Dt of 1Dri~1 ~11t1Oft - typr... Iarbuc1l, let1ud Area lIIId Iari~tIll, -IU" .....,
<br />Mater/hl"'ter If_.t
<br />· IoutMIt floridl Mater ...,~t Dl.trlct . WaU., eyprue ..,.., IftUud 1rUI, llterllt ..___
<br />· Am Q:lnI of IIJliii . ...111, DocU, "'lgable Wltena,.
<br />· Glllil.t'if lJI!iiTllllUJllbtln lull.. IJtrlrGlllllltll ,Ieolth lllit -1IeIII. iIIItMIIr rz.t.t, IIItlG r.Io
<br />I Ullf!!.t".J]l!tIl" ~CIl ~ - Albeltoe IbItllent I
<br />11110 .uf, tut, f fill _terilll, to be _ ill rlood loDe -.' or .A,ete.', It i. ~ tJaat . dnlIIp pllll
<br />IddrMIlIg a ......UDg 101.' .111 be .anted .bicb I, ptQIred br I prof....1oaa1 qJMIl ng1lt1n4 II tIlIltItI of
<br />Plorl" prior to pealt 11IUIACt.
<br />
<br />I pe.reU ...... 11III1 III ..trued to De . 1IC1D18 to proceed ,Ill tile work ad DOt u .kilt to tlollte, CIDl alter, or
<br />..t aide .., ,,"Iou of tile tec:bD1cal c:adea, Dot 11II11 illUlIlCI of . pIrI1t 'mlDt tile ..._ OfflOll1 ,. tlllndtlr
<br />r~d., I oornctItI of enotI Ira pl., eatr1lcUOII, or ,lo18UOIII of an, coGI. .., JIIIlt S.... 11III1 .... 1DI11t
<br />uaI. * .. -,... br hda petlit II ~aced Idtblo .1I_tat of 1I11l1ACt, or 11 .t ..... " U. pait 11
<br />IUIpIDlIII or ~ for . perlocl of .illlIItbI ,ftar tile UII tbe 1101'1 fI ~.eed. GII to .., ..... If till, III III
<br />all... for * palt .Ub f.. c:IIaqe of ,15.00. !be II_Joa ..11 lie ~ 1lll'1Ulg to tllllISWIg Oft1cW. III
<br />approtld ~ _t 11I1_ 4vdng eacb III alii period, or till proJlCt .111 be ~ Ihn'''.
<br />..0; 10": ,. mUll 10 BalD A alCl or 0IIIICRft III I18ULr Ill1XI PIIIIi IIICI .. "-.II 10 1M
<br />PDIIIr. I' III, UIIIID to CIIIII ftlllCllG, aJIlII 1118 fOUR ..... ClIlIIIaIIf 8IfCIII .... DI DlCI or
<br />aIIIDI>>IIIr. .... P,. U VIl.UI 00 lOr _ to .. lID l'08f I -ala or ~.
<br />
<br />u1i$;f!!'J/O~
<br />
<br />if1tI;:t!ifJ~
<br />
<br />mD Of ~ mu or rumrJ....
<br />aim 01 ___ \-Y'(ts C 'D c:ourrr or ----.Jt'lt S C!...o
<br />'he fongolag 1u~~t .... acmowledged 'lbe for890iQ9 lD.t~t ... ac-.ledpd
<br />beton .. till. ~ _, 19~ by . before _ tbi. ~:!:>, II cty by
<br />
<br />~MD,JbIiJllle.---- ~ /)fQ/Jf/lJlikAJ
<br />1* y . bOIID ~ or ..bo bal j~ 1 .111' aowa to .., or . ....
<br />pr___ . proclucecl
<br />u ld-.UftcaU.. 8Dd who did/did Dot u identification aad MIlo did/cl1d Dot
<br />~.. O&tlJ.o. ~~ . tit. aD CHJth. .
<br />
<br />~~ JAMES A. STONE (8. re) JAMES A. STONE
<br />(1_. TJped, PriDted o:r.r~.' Stale ur Florida (X_ Typed,' 'riQted or 8 ~ry U , ate of Florida
<br />110'\''' I'UBLlC lIJIy comm. expires May 16. 1995 HOTARY PU8~lC My comm. expires May 16, 1995
<br />CC110274 CCii0214
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