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<br />k.:RMIT APPLICATION <br /> <br />UTILITIES LOCATE CONFIRMATION NUMBER: <br /> <br />PROVIDE SKETCH IN THIS AREA, IF ADDITIONAL SPACE IS REQUIRED, ATTACH TO THIS <br />APPLICATION. <br /> <br />,. <br /> <br />AFFIDAVIT: Application is hereby made In obtain a pennit to do work and installations as indicated. I certify that all foregoing <br />information is accurate and that all work will comply with all applicable codes, I uilderstand'these codes shall take precedence over all <br />approved construction documents, and issuance of this pennit is verification that I will notify the property owner of Aorida Uen law <br />req., F,S. 713. . <br /> <br />The Issuance of this permit does not ensure compliance with deed restrictions and I understand that additional deed <br />restrictions may apply to this property. <br /> <br />All work shall comply with the alrrent Florida Building Code, pubrlC Works Design Manual and FDOT Design <br />Standards (if applicable). (Public Works Design Manual onfllle link: WWW.d.zephyrhills.f1.US/public_works.asp) <br /> <br />APPUCATION IS VOID UNLESS SIGNED WITH PROPER IDENTIFICATION AND WITNESSED BY A PERMIT <br />TECHNICIAN OR NOTARY PUBUC. <br /> <br /> <br />NOTE: The City of Zephyrhills is not responsible for maintenance or repairs of driveways. Driveways shall not alter I <br />interfere with existing stormwater treatment and I or conveyance. <br /> <br />By signing this application: I certi tha aye read and understand the owner/bu' der disclosure <br /> <br />(Pr.lease~i~L)' I <br /> <br />+- -0 l V( '-a-/'J.-r k 7 <br /> <br /> <br />Date <br /> <br />s-iz 7' ((','7 <br />Date / <br /> <br /> <br />Applicant Print Name <br /> <br />C'"F"f~h...~ <br />Permit Technician Signature <br /> <br />Applicant is ( ) personally known to me or produced <br /> <br />(type of identification) <br /> <br />as identification, <br /> <br />Page 2 of 3 <br />