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<br />. . .;:"::';""1.~=,r;4' r"HU 10; i~ 11):
<br />_... _~.s._' lJC I ..J ;;;>
<br />
<br />iCot... NO:
<br />
<br />1:*318 P02
<br />
<br />CONDITIONS OF PBRMIT AFFIDAVIT
<br />A. .B/;Y' OP DDD RBSTRICTIONg
<br />rill ...... tMt tQ. pUI1t ., bllubjlCt to llIIed 11Ittlet1.- lbIu IIf be .. rlltrkU" tIIII tltr
<br />r..u.. De.....gua..... r.....Jbillt' for c:cIIpU" 11th .J app1lcJbl. .. -~. '
<br />.. UJf{,I~SIQ) ,COlft'RACTORS AND CONTRACTO~ RB8PON8XBILITI,.
<br />If tile _ .. UreA . _tractor or COIltractO'" to undIrtUe IIOIl, tbeJ .., 1>>1 nQUlnII to .. II__ II ICClDCtMCIld.ti
<br />ltate .. 1oca1 nguIIUOIII. If tile coatelCtoI SI aot llctl8ld . nquirld by 1., Ilotlt tM .. ... atnctor ., ..
<br />c1~ for al1ld_IDOt 'iollUoa under ltatl 1... If the 0IIIIl' or lDteDlJe4 caatractor III IICIrtIIa u to.t l1...lag
<br />~lr_tl.., Ippl, for tM Intuded IOI'k, ther are ac1villd to COlStlct till eltr of IIpIIrrWlIIdWat ~t, ('U)
<br />188-6611.
<br />hrtllnn, If U. .. .... .104 . COIltractor or contractor., lit I. add'" to 11m U. ClOItrICtOr(.) .Ip portlaM of ~
<br />'CGltrlCtOr IIctJ..~ of W.lfPll"UCIl for lIbirJa tiler all lie r..,.lble. 11 fOU. . tJIe _1111 . II ...,
<br />JW 1ft iJllcaUDg tilt JW, rlUlu tIlIa tM eoatrlCtor, art reapouible for tbe _k, If tM .tnctor .... !II to 11"
<br />II COItrICtOr tIlIt .., be u WlcatlOll OIt be 11 DOt properlr llCWtllID4 II DOt ..Uti. to __ Jddllgllla -
<br />eu, of 1."'01111. _.
<br />C. 1R4N8PORTATION IMPACT "&88 AND UTILITY CONN~CTIOH nu
<br />D. COJI''l'NION LIBN LAW (CHAPTER 113, FLORIDA STA'1'U'fBS, AS AlllllDBD)
<br />1 cutl" u..t, appUCIDt, ... _ pm1Wlltb I copJ of "lorlda', COUtnct1aa ... LII- .....,.. ftotICUoa
<br />Gulc1t1 pnpull1 br tU 'lorUa DepatbleAt of Agriculture u4 COIIMU.' Aff.b.. If till appUeIIt It __ otIlIr tMD tile
<br />ICMDU', 1 cut1fr *t 1 .... !lbtllDtd . COP! of tJle Iboft dllcrlbed ~t 8IId pc... iI ... h1~ to GIlI_ It to tJII
<br />'0IMr' prior to 4lG-I~t.
<br />
<br />s. ~'8(J*NIR'S AF~JDAVIT
<br />I CIdlfJ - tllat ell * WaallUOft la W. 1PP1IeatlOll i. ..rite IIIlJ tblt aUlOl'k will be ... Ia .... .l~ all
<br />epp1JClbII 1.. I1II1ttIDg _~CIl, ICII1DCj, - I. -lDl*Dt.
<br />Ippllcata .. ... .. tlj oIItaiI I perlit to do work ID4 l111taUaUCIG U lDdiCltlll. 1 certlfr cut 10 .... or
<br />iDltl11aU. .. <0" r I all prior to lIIlJ1J1Ct of . peait IIIl1 tbIt IUIOI' vU1 .. IIIff_ to .. ItIIIMtI of 111 ....
<br />reguJatlag OOIItracUOI, eitr CAJdu, lOlling fI9\lIIUOIII, ad 1_ dI't!oJIIIt rlplaU. In ~ jarltllctl.. 1 alto
<br />certifr tMt I ..atlll tIIIt * regu1IUant of oUllr p_bl ....11I appJ,.u. tile IatIIIIIC, ., tMt it II
<br />II __'_IUq to Uattlfr .ut leU. I at tab to lit 10 CGlplluce, 8uc111t.~i" IDC1gllat In -* Illltlt to:
<br />. ~t " "'~11ta1111t1Oft - Cypr... ...,..., htlu4 &rill 1llll1a,w-tI11J ...IU" .....,
<br />.t.,......ter tna_t
<br />. 1ou\JIIII$.f!or* .. JIuIa..!t Dlltrlct .. 1111., CJpnu 8QIlul1I, IfItlu4 lrf'" liter... ..ter__
<br />. B...9!Ifjf II!!!s - 1IMJ1., DockI, "'lgabll ..tene,.
<br />. ~jf ~Q t lIMbilltaU" Slnl.. ~lr_U111e11tb Uait . Ilellt4 lfutMtIt '*'-t, llfUo lab
<br />. UlI1'~ _1ItDCI - llbatoa .~t I
<br />I a1Io OIrtIfr tw, _ III .tulall. to be _ ill Flood IoDI Il' or 'a,.te.' t it illIIIlIInteolI ~t . __ pl.
<br />IdlnISII . .~ rol.' 11111 be IlJIlIltt.. Qic:lll, prtplnd by a ptDf_CIIIlIDgiI.r reg..- II tIIIltIb of
<br />Plorl4l prior to ftIIlt I....
<br />I pere1t .... ..U .. alIIItrued to be . ll~ to proceeO Il~ ~ .rk .. tel ..kitr to ,ltlHe. ..a alter, or
<br />.t aide .., ,.1I1oM of tie bcIIatcal cadet, DOr lull itIUIDCI of . perIlt'llmat till tIS_ OfflOlll ,. ...,tat
<br />r.dlll I comctIOI of erronlA pllll, _trucUon, or YlolltlOlll of Ill' "II. ..,,.at... .Ikll .... lm114
<br />.11I tM ... eaklHl1 bJ . penlit 11 oo.IDCIl1 ..Itbln .11 _* of laB~ or 11 _k ...... '" till pait I'
<br />...... or ~ for . perlac1 of ,iI _tbI .,tH tJIe till tbe *k 11 t.t.... QIe to tit .... of tile, III .
<br />aU_ for tM penlt IUb fll c:Iaaqe of ,15,00. !1Ie __loa lUll be ~.lJllI'ltlJlg to tblldWlg Off1cW. III
<br />IpptCMl1 ~ _t bal_ _1119 ..cia III _~ period, or till ,roJrd, ,1111 be CGldOln/l ......
<br />_118 to..: .. 01_ to IICOIlD A ala or ~ 11I1 RaUL'!J." PlY. .. III ..... 10 -
<br />PIJl'JIff. U 1II1IIIIl1O ClUU fJIIICllG, a.suL! VIII fOOl .... CI II ~~ ... .... 1UUIIIlCl Of
<br />
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<br />Stili or , ill a. ()
<br />CDIIIY Of' . Y(}S eo ..
<br />'lb. fori~i~g lD.tl'88D~ - aclP\cNledgeld
<br />before ";itlll1 --1fp1l,,,,),/ , 11 rr/ br
<br />.1f'l11~,.J /:J,4A'/U'''-'
<br />~":~f:-~ ... JtO .. ~- .... ....
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<br />tile -~~ a $/~
<br />(11~~~71 , JAMES A. STONE
<br />(N_ ~~_l, Priuted ot 8t.~\ary PUDIIC, State of Florida,
<br />.....llIy 1~'}lUf! My comm. expires May 16. 199,
<br />~. ,..... CC110274
<br />
<br />1'1&11 or- JV [)
<br />GIm ' yA~O.
<br />,.... fO.;.,t ".. acbowledged
<br />Won.... No v. 02 / _, 19...2;L by
<br />~.:-
<br />~r.O' ~
<br />
<br />(r4" - ..QtIId ,-- E
<br />Jf9'~1if' '~"'" ~)\lOfary Public, State of Florida
<br />y comm. expires May 16, 1995
<br />CC110274
<br />
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