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PART 8: . A. By signing this application form, I am appying, or I am appying on behalf of the owner or applicant, for the pem►it and/or proprietary authorizations ident�ed above, according to the supportin� data and other incidental information filed with this application. I am familiar with the information contained in this application, and represent that such infortnation is true complete and axurate. I understand that knowingIy making any false statement or representation in the application is a violation of Section 373.430, F.S. and 18 U.S.C. Section 1001. I understand this is an application and not a permit and work prior to approval is a violation. I understand that this application and any permk or proprietary authorization issued pursuant thereto, dces not relieve me of any obligation for obtaining any other required federal, state, water management district or local permit prior to commencement of construction. I agree, or I agree on behalf of the owner or applicant, to operate and maintain the permitted system unless the permitting agency authorizes transfer of the permit to a responsible operation entity Typed/Printed Name Corporate Title, if applicable S' nature Date B. AN AGENT MAY SIGN ABOVE ONLY IF THE FOLLOWING IS COMPLETED: I hereby designate and authorize the agent listed above to act on my behalf, or on behalf of my corporation, as the agent in the prooess�ng of this apQlication for the permit and/or proprietary authorization indicated above; and to fumish, on request, supplemental informaUon in suQport of the application. In addition, I authorize the above-listed agent to bind me, or my corporation, to perform any requirement which may be necessary to procure the permit or authorization indicated above. Typed/P ' t me Owner or Applicant Corporate Title, ff applicable �� Si re f er or Applicant Date ' � C. PERSON AUTHORIZING ACCESS TO THE PROPERTY MUST COMPLETE THE FOLLOWING: I either own the property described in this application or I have legal authority to allow access to the property, and I consent, after receiving pnor not�ication, to any site v�sit on the property by agents or personnel from the Department of Environmental Protection, the Southwest Florida Water Management District and the U.S. Army Corps of Engineers necessary for the review and inspection of the proposed project specified in this application. I authorize these agents or personnel to enter the property as many times as may be necessary to make such review and inspection. Further, I agree to provide entry to the projed site for such agents or personnel to monitor authorized work if a permit is granted. Typed/Printed Name Corporate Title, if applicable �� jC'_t � ��°1.Q' � e. �'i�.OT � n� � y��, �' 1 ( � Sgnature � T Date D• I certify that the engineering featyres of this surtace water management system have been designed by me or under my responsible charge and in my professional opinion conform with sound engineering principles and all applicable rules and specifications. I further agree that I or my engineering firm will fumish the applicanU permittee with a set of guidelines and scheEules for m,aintenance and operation of the surtace water management system. -� _ -�- , y By , ' � j �( � ��i Dario A. Herrero 67796 Sigrtature of Engineer of Record Name (please type) FL P.E. No. DDSM Consultina. LLC 28875 • A F F I X S E A L• Company Name EBN Date: '�'/' " �// 14359 Miramar Pkvw #327 Company Address !�'��- �%� S! Phone: r,} 3-�'�, ( Miramar. Florida 33027 Ciry, State, Zip FORM 547.27/ERP(8-94)A Page 5 of 5