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<br />CONDITIONS OF PERMIT AFFIDAVIT
<br />A. NOTICB OF DBED RBSTRICTIONS ,
<br />11Io ~ -tudo lIIot 1lI1, lllI!tlt 8IIJ' lie -8Ubloct to .0.... mtrleti...,. 1lllJ0II .., be lOtI nm-lcUre tIIa Clq
<br />regulIUCIJ" fJJe W14enigaed 11111I81 responaJbUJty for COIpUanC8 lith an, appJiclble dnc1 restdcUOIII.
<br />
<br />a. UHLICBJf,8ED COlt'l'RACToR8 11Im COlITIlACTOR !m8PON8IBILITIII:S
<br />If lInl .... .... 11I1'1II · CCIIltractor or COOtr8Ctore to unmtale 110ft, IIIey 8IIJ' lie """'1'1II to be ~ II ...... ,11II
<br />.tata IIIIIIloal IIgOJaU..... If tb8 ""'tn,tor i, ..t 11-.01 .. ttgIJ.... ~ lb. bollllllo _ ad CIIIbIctor ., III
<br />cJtad ror .III~ 'lal.U... ""'" .tate I... Iflllo _r or l.tlDded ""'tractor III -.uta . to lIRt u-q
<br />"""''-11"11' appl, ror lIIo lateode.lllOft. the, m ad,i..! to OOIIlIet lho CUyof Ie\lIlrrblllo IallIlat IlrtIrtat, l8l3l
<br />788-6'11.
<br />
<br />'.' ..~,.~
<br />
<br />1'IIr~. Illllo ... HI bll'lll a ""tr..tar or coatractoCl. .. to IlIrIel to llan lInl OlIatractorl.IIl!lll (IIIrtlaq Of lII8
<br />'CGitrllCtcr 18otMe' of 1lI1, QPJlraU", 10< IIblob lII8r 11111 be CIIJIOOIjbIe, II,.., . lIIo ..... 'IDe II lII8 0IIItrIcI0r.
<br />"'" III loaaettag lIIot JIlII. dlll8r lIIoa lIIo ...trartor. ere _me lor lIIo 1IOCt, Iflllo 1IIIllr8Clor IIldeIIlIlI to Ilga
<br />II alIIlnrIor tllat IOf lie .. loM..U", lIIal lis to nol PfOllIrly 1I0000llllllto 1101 ",UUed to ponttu.g lIrldJegoe IlIlIIo
<br />City of ~fll..
<br />I C. .TRANSPORTATION ~HPACT FEES Af\ID UTILITY CONNECTION FU!)
<br />D. COJIIS'J'Rl/C'rIOlf LIElI' LlIN (CllAPTER 713, FLORIDA 8TATII'1'ES. AS AIIBIIDaD)
<br />1 .....ulJ lIIot I, lh opplleaot, """ ..... _tOed ,11lI . coPr or 'florlGl'e CllaelluctJ", LI'" r.w . '"-er'. PIaUo:U",
<br />Guide' P<\IIIItIII .., lh "0tldI iloportaoot or ~r1C1JIt... IIIlI Conwer Ifr.ln. If lIIo ",If eat II _ otIlor tIia lIIo
<br />'-', I OIttlr, tllat I ..... -....0 · '"PI' of tile abon -lIlId ~t IIIll proaloa 18 IIl10ll flilll to d.U", It to tb8
<br />.011I11'. prior to c:c.encennt.
<br />
<br />E. COIITIlACTOR'S/PNlfb'S AFFIDAVIT .
<br />I certlf, lII8t: III Us lDfomtIlIII III 1lI1a ....1I..UOll Ie a""rato 11IIII lII81 .11 1IOCt ,m be _ JO CIlI1I1'- ,ltIllll
<br />applicable JM regulating coutruCUOII, lOlling, and land d.velGplent.
<br />IIl(>lIratloa I. 8enbr """ to olllllll , PIl'IiI to do 110ft "'" 1lIatal1.1I.. II lodlrated. I c:orttfr tllat IIIllltt or
<br />IIIItII~lillll ... - pd01' to I....... or . .....It iIlIlI that .11 1IOCt ,III be perlllllilll to _ 'lIOiIede of'lll ...
<br />regulatlog ....lractl... Clt, ...... lGOlag regul.tl.... 8Id lIDO detelQpllaI regallll... III JIo lerfedlctlaa. 1 alao
<br />rortlfJ tIIIt I aoderItIIIlIlfIat lh reguJall... or Olller go_tel ..eo "'l IPPlp to Us IlIleaded IIIlrl, ... lII8t: It I.
<br />If ruponaJblUq to IdlllUfr Qat ICtJOIlI I .ost tate to be in cOIpUance. Such Ifenci.. laclude Ilat an DOt U.JtId to:
<br />· D8Jertaen1 al...~ _laU... - CfprlllllarlJeade. Ifrtlllllllama IDO latI-lIIlf IIu.IU.. .,
<br />later/lI.taaler rn'blat
<br />t 8outhe8t rlor~ lIIna..t Dlatrlct .. Ifelll, c,pr... Ba,headl, Wetland Areae, Altering IIttrCOllrlel
<br />· k.J eon. of j!j _ .. "aU., Doe." ."igable lIaterva,.
<br />· I of 11II11I '1aIIINIltaU.. Senl.. IDYl_tal 1IeII1lIlIoIt - 11I11.. IaIlIIIter~. lottIaloW
<br />· UlIDtl-W Pnteatloo ~ . IIIleIllIa ~t ,
<br />I 01.. aertllr tllat, II fllJ .tld.1 ie to be UIId III ".... 1008 'A' or 'A. ete , '. It la lllIlIenIDld lIIot a dralaeat pi..
<br />Illdrwblr · ''''''''Uog 1VIlw8' ,III be 8lIhIltted IIIIleII II P"1IIIIlI1lr a 1>lOflllllllltl eog/lIIIr revJatend Ii ilia ItIle of
<br />Florida prior to perllt J.SUlllet.
<br />A P!fIlt IIIlIId 811a1l !Jo .....trued tolls a II..... to PI'OC:OId .ltlllII8 rort iIlIlI 001 .. IlIlIIorlq to tlolatl. tIIICIllltlr. or
<br />Ht ..Ide Illl' _1,111III of lIIo tIdlotJcaI 0llCIee. IIOr olIall I8euooee of . PIflIt _t tile IlIl1dbg Dftlclll ftlll tb8raarllt
<br />rttalrlog · comctl", of ormn III pi.... COIIIlIuctJ.... or '1lIIaU... or IO, rode. ...., PIl'Iit 1_ 11II11 "'- IarIIId
<br />11I1... lIIo 1IOd ..tllarl.... .., ..011 .....11 Ie -- .ilbia .1. IlIOtIIe or I........ or If....t ~ ., lIIo PIl'Iit I.
<br />- 01' eIIaiIoIled lor · Jlltl"" Of IJJ IlIOlII8 after tbo tfIe lb. IlOlll. _. IIl8 10 dop ~ at tloa, ., lie
<br />all.... lor tIIa pontt 1d1ll1ee dIaqe or 115.00. I'IIe atwl", IlIaII be r_tad III rrlUog to lII8 IlIlWor OfflalaI. III
<br />approved IDIJl8CtjllJ lUSt be logged during tech 111 lOath period, or the project lill be COIIIhllr1l1 ~.
<br />UIIIllID lIIIIII: IIDI fAILIIIIr ro IIlIaIID A iIIIIlCI OP COIIbCIltIIIr III' JIIlIIJ/,f IIIIIUII PAfIIlIlIIt:II fllIlJIIIlu".q I\lIDlll
<br />PROPDn. If IOU IJ'J'DD to oml. FJlAlCIIfG, CONSULr IlfB YOUR LIIDII OR IIlftCIIIIr .. IICCIIDUQ IOIJR JOIICI 01
<br />CXIIJIUCJJIur. J08B UlDIR '2,500 Iff VAWI DO lor lIED ro RBCORD UD POS! A 'alCl OF c:tIlIII'Cauur'.
<br />f( ~
<br />
<br />81GJllruU: omit OR AGllff
<br />
<br />
<br />SrA1'1 or PLOIIlDA
<br />coum 01
<br />The foregoiDg instl'WD8Dt "'as acknowledged
<br />before me this , 19 by
<br />-
<br />
<br />Sflfl or FLORIDA
<br />COUI!Y OP HillsborouJZh
<br />The foregoing iDstruaent .a8 aCMowledg8d
<br />before lie this 2/26th , l' 96 by
<br />'OTHtVLEl.{ f<,.. HHIVk./tJS \jk.~ .4Nb
<br />~ E T r-J J<'.. ~ J-/-t; IV R {Q,f JE7-
<br />vh Jper80nally knoiii:'to .. or who ba.
<br />produced .... '"",,, ....~
<br />a8 identification 8Dd"wbo did/did Dot
<br />t an.oe.tb.
<br />
<br />
<br />who is perlODally knOMn to me or who has
<br />produced I
<br />a. identification and who did/did not
<br />tale an oath.
<br />
<br />(Signature)
<br />(Hame TYPed, Printed or Stamped)
<br />NOTARY PUBLIC
<br />
<br /><
<br /><
<br />(
<br />(Hue Typed, 16296 ~
<br />NOTARY PUSLI Of"'\) MyCommission xpireaOl/251OO (
<br />. I 1-800-:J.NOTAltY - FJa. ~Sema.a:lIoadiDsCo. ~
<br />. ~((((t(((((((((<<((((((((((((((((((((((((((((((N~ (
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