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� NOTICE OF INTENT TO USE THE GENERAL PERMIT FOR CONSTRUCTION OF FLoaA�tsA" WATER MAIN EXTENSIONS FOR PWSs INSTRUCTIONS : This notice shall be completed and submitted by persons proposing to construct projects permitted under the " General Permit for Construction of Water Main Extensions for Public Water Systems" in Rule 62-555 .405 , F.A. C . AT LEAST 30 DAYS BEFORE BEGINNING CONSTRUCTION OF A WATER MAIN EXTENSION PROJECT, complete and submit one copy of this notice to the appropriate Department of Environmental Protection (DEP) District Office or Approved County Health Department (ACRD) along with payment of the proper permit processing fee . (When completed, Part 11 of this notice serves as the preliminary design report for a water main extension project, and thus, it is unnecessary to submit a separate preliminary design report or drawings, specifications, and design data with this notice .) All information provided in this notice shall be typed or printed in ink . The DEP permit processing fee for projects requiring the services of a professional engineer during design is $650, and the DEP permit processing fee for projects not requiring the services of a professional engineer during design is $500. * Some ACHDs charge a county permit processing fee in addition to the DEP permit processing fee. Checks for permit processing fees shall be made payable to the Department of Environmental Protection or the appropriate ACRD. NOTE THAT A SEPARATE NOTIFICATION AND A SEPARATE PERMIT PROCESSING FEE ARE REQUIRED FOR EACH NON -CONTIGUOUS PROJECT.t * Except as noted in paragraphs 62-555. 520(3) (a) and (b), F. A . C. , projects shall be designed under the responsible charge of one or more professional engineers licensed in Florida. t Non-contiguous projects are projects that are neither interconnected nor located nearby one another (i. e. , on the some site, on adjacent streets, or in the same neighborhood). 1 . General Project Information A . Name of Project: 92" Court Waterline Extension B . Description of Project and Its Purpose : Installation of 315 LF of 6" PVC water main and 500 LF of PVC for (2) 1 1 /2 " water services lines with two residential meters to support private, residential connections for (2) homes. C . Location of Project 1 . County Where Project Located : Indian River 2 . Description of Project Location : 92"d Court; Sebastian Florida D . Estimate of Cost to .Construct Project: $ 13 ,000 . 00 E . Estimate of Dates for Starting and Completing Construction of Project: Start: July 2012 Completion : September 2012 F. Permittee PWS/Company Name: N/A PWS Identification No. : * PWS Type: * Communi Non-Transient Non-Community Transient Non-Community Consecutive Contact Person : Mr. Jesse Roland I Contact Person's Title : Owner Contact Person's Mailing Address: 7760 92 " Court City: Sebastian State : Florida Zip Code : 32958 Contact Person's Telephone Number: 772-633 -9282 Contact Person's Fax Number: Contact Person's E-Mail Address : captainsurfer2003 (@,yahoo . com * This information is required only if the permittee is a public water system (PWS). G . Public Water System (PWS) Supplying Water to Project PWS Name: Indian River County Water Distribution System PWS Identification No. : 3314052 PWS Type: Communi Non-Transient Non-Comrnunity D Transient Non-Community Consecutive PWS Owner: Indian River County Utilities Contact Person : Mr. Gordon Sparks Contact Person's Title : Plans Reviewer Contact Person's Mailing Address: 180127' Street City: Vero Beach State : Florida Zi Code : 32960 Contact Person's Telephone Number: 772-226- 1823 Contact Person's Fax Number: 772470-5143 Contact Person's E-Mail Address : gsparks@,ircgov.com DEP Form 62-555.900(7)Attemsfe Page I Effective August 28, 2003