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<br />'''''lU~ ~'H).I'Ii:! \.!.~' .':',I1:R~E'!,' 1\E'E';:::lAVI'J'
<br />
<br />A, NU'I'TCHI OB' UBlBlfl RHlB'l'IUC'l'IONS
<br />'j'be lilldeJ.:sJuned IllHlf:ll:stcillda tbat thia pi=rll!l ~ IO<lY Ill. sqIIJe;ut: to "deed J:6sl:J.:!fJtjOlla" '1'lll1ob
<br />IIlItV IJf:j ill(H:6 Leat:l.'lc1:Jve than CJ.ty regnlatiOlls, I'hl' ,mdIH,dYIHH.l alUllllllf:iii J:aaponaHd lJI:V tor.
<br />uompl.l.anue \lith allY applJcClule deed t:estrl(Jl~.1l)lla.
<br />B. lINl,J()/iINBIilU CON'l'R1\{j'l'URS AND COll'1'HJ\C'l'OR RlUSI?CJN 9:BIIlI'I'.:.ff:,g
<br />1 e the CHme!: hila hiu.d iii uontl:autol: Dl CJOnt,:l!lct.o I;fj tD 11lldlOltta)ce I'wrl" they \I1l!lV be I::/iHjILl red
<br />j 1.1I be IJulCllHullj Ju i1Duordanoe HJth st:at:e and local. J:eglll.lUolla. It the aontrl'ut:cH:.Ia lint.
<br />LJ,llilllsed as l:eqlll ted by Jaw, both the: OHller and iJCinl:n,j u\:o!: llIay be nl ted f.lH: a lilt adilllltlliillHlr
<br />l),llJ]al:l11n 1I11del' fltat:e lau, If the alme.!: or J\lLelldE:I(,1 UO\ltl:al1tol." are llllrJ61:ta.ln fUI to Hila\:
<br />UCJf:lllaJIlY relJlli.tellllelll".s I/Iay apply tu,t: tile intended Imrk, they at'l:'l advJaed to CJOllt;wL the
<br />(~ILy of Zephydd L!ii fUdld,lng Department, IlD-',Illfj'661l,
<br />li'IULhfHIIIClJ:Ei, lf the Climer has h.tred a aontrclotoJ: cr oOlltl:i'lotars, hl:l J.s ilL:.\v:!sltcll:o Ilave the
<br />cWlltl':flCJt.Ol: Is) 1:l1gn port:.iaIlS of the I\Cont~raotol Stlr:t:iolls" of thts appljc.lat:lon t.Pt Hhloh t:hljY
<br />11111 Lfl' J7iUiponalhla. If you, as the OHner. algn.s f.jll the rwntrautor, you are j,nd,ltlal:lng thl'll;
<br />you, rather t:hSll the r:olll:.t:aotor, al:etesporll:I1,ble fol.' the Hurl" J f the ocmtuwl.:t!l: Illlilhea
<br />you l;o algll IHi oOllttaotcll that llIay be an lndlrJal.:lol1 lhat he :Is nnt );lJ.:aper},y ,L1uiiilUled illld Is
<br />lIul, iillIt:lt:led to pel:III1.I:t.illY pr.ivileges 1.1l thel CJt\1 of ~,ephYJ:hllls.
<br />c. 'l'HmIB~OH'l'A'l'HJN HU>AC'l' Ii'HlIlJS Al/U U'l'ILI'l'Y CDNlllilC'l'lON li'l1~IlJS
<br />lJ, COllS'I'AlIC'j'llION l,Tlll11 IJ,W (Cll1\I?'l'l!JR '113, H'LORIIlA ,'j'l'Alj'lI'PIES, AS At1IDNDU:n)
<br />I eJ(HI:l ty that: 11 the appllollllt, have betln IIJ.:Dviclad \11th a aOllY at "Jj'loJ:":J.da' 5 t:onstr.'lloL:lc?n
<br />.11,,11 l,a\1 . jhJllIiHllmer'ij I:>J:otiilotion Gulde" prepared by tile B'lor.ida f!firllilfl:lIlenl: of Aurloull:lll'fi
<br />c\lld OUlU:IIlliler lIffab:s. 1:1' the app,l.j cant is aOlllIiOW;l ot:lIe~:, J.:h~t the "CJI'II\IU", J eHolcl ty l.:hal: I
<br />lIa\!e obtained a (JOllY of tho above dCiliorJbed tjo{]\unent: and PtoJn1.se JII goodfltith I:() cjeli,lfli[jl'
<br />j I:. 1:0 the \\ Ul'IlItll"" 11 d. 0 r. 1:0 OOllUnenn6111ell t .
<br />m, CDN'L'HJ\C'l'OH' fJ/OWHIilH' B AFII'IUAVl'!'
<br />I uertj fy Lhat all tile informatiQn in tld.s appUcatl all 15 aocurate and thal~ Jil,)J, uQJ:I. lJl11
<br />be done 1n UOII~U.allcle HJth aU appU.aahle laws regul.ating oanatrllotiull, zOll1119, tllld lalld
<br />c1eveloplllliiIllt.
<br />JiPpJ..lo/:lLJon :Is IHH@hy mqde to obtain 1':\ permJt to do I'wrl. aliA Jnsl:i111at:.1elll tiS j ndioatect. 1
<br />CliHL:tfV 1:11..1: no Hod. Ilr l.11ClL:al.lliltion haa uommenoeei prJpr to i1:ljillaIJCJiI elf Ii pennlt and Ihid:
<br />all I"/Otl[ IV:!.!1 be PtlcF.Ot'll\i;t! to miilet st:~nciards of all laws regulating oonaI:J;uCltJon, U11:y
<br />!lodes, ~allJllg tegulld:.lolls, lind lalld development Ulo\:llllat1.o11s .In the jllJ:':l.sdl.ution. '[ alaI)
<br />Ge:ll:! f.y \.:11011: '[ 1IIHieraLand that Lhe l."eglllatiOllS of. other goverlllnlillll:al agencdes Illay apply 1:0
<br />Ille l.nb"lIdcHj ~ml:k, f:lIHl thai: it ~il my 1;',,.ppn.lt.u~iH,tfj tCl l.delll:Jfy l'Ihat aul:.1.ollli1 I 1II111i11: I,ill.. 1:0
<br />be ill Gumpl.!ftlloli>. Blwh agenu.lfl8 .i.nCllllde bllt are \lot: limited tOI inepil.rl:ment of
<br />EJllvi t:Ollllllilllltal RegllJal:ioll'-Cypreu B~yheacjc:l, Wetland Areali lllld lJinvl.roIllIlEilnl.aLl,V BelliU:j Va
<br />l.a \lds , Will: tll'/Wa s l: iilllill: e r 'l't ea Lmen t
<br />AaO\JLllI~elit: IJ'Jcnida '~iit:e, Ni4l1agelllelll: IJJ.atd at-Wells, cypl'eas Bayheada, WeLland }\I:eas,
<br />A II..dll!J Wal:el:CJOIIUlba
<br />A IU:IIIV COll11:I of IilllgtlUIl!lr.a-Beal~aLI.l:i, Donhlii, Navi gable Wa terl'la ya
<br />A)ltilpa/:lIl1~Hll of Ileal th it RehabJl.iI:aL:1.viiI SiiHvioes, Ir.nv1.J:Olllllilllltl:\l lIeall:h IIIl1.t-Wel.llill
<br />Waj;jl:e~lal:iu 'l'l:eatmlilllt:, Be~lt:if.l '.l'fll11~f;l
<br />~IJ, S. Iilllv.ir.flwHelllt:al l?.a:otealJo1\ Age\loy-Aabestos ahatllllllll:l1t
<br />'I ~lti{J Utll.LJfV thflt, if fLU llIatl!lr.I,a.l Jill to he IHoled in Ii'lond ZOlle "A" Ol' "A,el:n.", .it.is
<br />1IIHifilJ:sl:oud that a dral11lilge pla\l ildd.l'f.IlSs1.l1g a "oolllpensaLJng vQlllme" wLU ho IilUllll\lt:t:aHI uhi.CJh
<br />ia pl.'eiliHed by a lJl.'otesaional eng.inei;ll' .t'eg.1.atered in the state of Il'lurlda pr:.ioJ:' I:{) peJ:lIll.t
<br />iOllllllll(le.
<br />1\. [HUlldt lsslJed shAll be clOllat.rued l:o be a U-oen$iiI to pJ:ooeed Hi th the HClJ:lc ilnd \lot as
<br />fllll:hn.rJ t:y to vJollllte, Ulil\Uel, alter, or set aside any Pl"ovJslc}Ua of I:he tsnllldnlil ooclelil,
<br />nDr shall :JIUlIllulCe of a peull!!: prevent the 611.11cl1119 otfi.oial from tlHH:fl~tt:cu: fliHJUJdll1j iii
<br />coruwLj elll of errors ill plaus, oonCjl;.I;uQI::1on, or viUl,jj1t:i01\i uf Any {Jg~il,. tilv.~~ patlll4,U
<br />i.UlIlIU /illllU lJlloome inVilUd unl411U1 the WDJi;}t Ill,J~horiud hy such pumit j8 nOlllllllilHJliHl ui L:hJII
<br />aJu lllfmtha uf iaallano., or tf ~wrJ, allt:ho,dzed hy lhe perlllJt 1s filllipellcted ot;' ilhilllClon.d for a
<br />plid,od of. al,J( months I':\tl:ar the t.1.me the liork .ia aOIlUllenaed. Dniil!lll dilY fuCtflllfliClII llf. time
<br />lIlav Le a 11eJl'/ed tor the lloJ;"m:t,t with fela oharc;Jl!l (If ~ 15. no. 'I'he entellfllnn I:iIhal1 h. l:iH)lliutilcl
<br />.III HJ:lting to the BU11dioy OtUnllil, An lilpprOlfeit! illspl,mtion lIlUSt:: be lClIHJliId dllr.:lng eill~1i I:lJIC
<br />month ped-tHJ, ur Lhe projllot Idll be aOllshta1:iild ahandorliild.
<br />W/HUIWu 'J'O OWNIlJRI 'tDun li'AI1IURBl 'I'D RECORD A NO'l'WHl OJj' COMt1I11NCHIHffiN'l' M1\Y HUlfWI,'l' T11~lllJR
<br />J?1\'iHIG 'j'WIClIl H'OH Ufl?HOVEMIilN'rS '1'0 YOUR I?ROI?H:R'J''t. IIi' YOll III~I'II:HD 'I'D DR'jl}\nl II'HIAlM1Wi, nmlSIJl/I'
<br />WI'J'II Willi l,Hlt/IJBlR OR AU A'jlll'ORNFJY BIllIfORJI', RlllcORDHlG YOUR NO'j'IC/!1 nil' CnI'1MUiNCIl1l41l1N'1', ,IOBa IJ1WHln
<br />~2, 51lU HI VAIIUIll no NO'l' HUlEn 'lln RlilCoRfJ AND 1.:'0B'j' J\ "NO'I'ICE: (JJj' c:m'1l11i1lWfilMIIlH'j"'.
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<br />... .,_.. '--_'__...,._~..~.-. _....1_._.~.....' ____.._~_...__ .~~_ .... '.'_.. ._.__._._..,._.._~..,___
<br />S]GNA~Unml DWNwn'UR AGENT
<br />
<br />~'I'J\'J'IIJ UU' B'I,URfll1\
<br />
<br />(JOII N'l' 'i U H' .___..'...'..__..'......___'.____..____.____.,_,_.....,
<br />
<br />'J'hill forfilvo.1ng iUfill:rllment: ~U\S aolOlo~llEldged
<br />Be to r e me tld s ...,_,_,.. clay 0 f '_____.__...._, 1 !L..,
<br />
<br />b \' ._ .._..__,.... ._._..,......_._.._ ....,._..,..___ _._..._..__."__,...,..______.._,.___....
<br />
<br />(nlilllle of llanoll iI(Jl(jlO\~l.eHigec.t)
<br />1II'Iho 1.41 personillly known to mei, or
<br />
<br />1.1 Hlw haa 11I:DdIlCJed,_._____,..._.__._,..~,__..__..._,...._,
<br />(typii of JdentJ.fJoatJon)
<br />i:lwl HholJdJ.cl [Jdld llOt take an oath.
<br />
<br />.. .. .-' ,.,.. ..~-_._. -- -'~..,_._.-........ --.' ..----.-~._._~--u~._........._.~,__._.,~_..._.~.....'"u._._ ,.
<br />
<br />SJynal:1l1:fl of pat:soJl taking i!lCllOlovll.edgement
<br />
<br />I~ all\~- -i~- yi'l'~~i ;.'(; ~T~;'t:~;i-;~~:' .;.l~.lIij;'~lj-...-.,.._--
<br />
<br />.__..,._--..."-..._-....,--_._,.~-----........_.._.-.-.~ -" ,.. -'~._.~..-_. '---'.. '''''.._...~,_._._ ....0' ,_""__..__,,
<br />
<br />B I GHA'l'llHEI CClN'l'R1\(J'\'IHt
<br />
<br />fi"l' A'l' EJ n Jj' D' I,O R I UP.
<br />
<br />COli N '1' Y 011' __'_...,._..._.......,..__,._,_.._... _...,...,_ ....'. .._...,...._
<br />
<br />'l'he fo l:iilgolng illS I; flllllell ~ 1-/11 ~ a olmol-116l(IYilcl
<br />BllIfore llIe this _.____f.iay of-...,......"..""'__, Hi _.:._
<br />
<br />b Ij ._....n..,".,__...._"..._.._..___.,. ...._. _..""_..,.,._.""._. ____, ....".. '._."___.
<br />(name of person liICJI(1IQW] IidU.ul
<br />Ulho 1a peJ:'lilema lly Imfmn 1:0 me, ell:
<br />
<br />[I \;Iho has pr.odlloed_____.,.__..__..,._....__.___"_......
<br />(t Yfla Cl f j delll:J f.i.ml t;j,olll
<br />and Hho l]dJd DUd not: l:.al[Ei! lilll olill:h
<br />
<br />-- '_....._'-'~.~....'~__._M._'.__..~__,...._"_._._,.._....,_...._.~.__._ __._._..._...,..._~..... ..,_ __...__._...._._
<br />
<br />Si,gnal:u.l"Et of pet'lion takillg aolmmll edglllent: I
<br />
<br />........-..--- ._-~.... .,_.....,,---~----,........_..- .... ...~.-~.--._..._.._,_.......-. ........ .... ..-----.-. ...- -,".- .._.'''_..__.~.__....
<br />
<br />Hallie typed, pr.llltad or a I-'Cllllped
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