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0 <br />- - -_ - 9 9 1 V %;P1 I <br />This sworn statement is submitted to Indian River County for the followin ect: <br />g P roj <br />STATE OF <br />COUNTY OF _s; _ Ly c , <br />Personally before me tf�e�und rsigned authority, appeared <br />administered, stated as follows: , who upon oath duly <br />1. This sworn91ement i�submi ed by the PERMOTTE_E, <br />who �a u <br />7s'nesaddress is <br />,,address <br />r ell <br />applicable) its Fe <br />d <br />e <br />ral Identification No.(FMN) is IC -7 and and (if <br />2. My name is Mrd qCL IJP [!ir��o,� <br />entity named above isand my relationship to the <br />(If signing as Owner's Agent, attach Letter of Authonzabon to sign from Owner) <br />3. Permittee understands and agrees that in addition to the Stormwater Man <br />System Permit, it is responsible for complying with, the terms and conditionss of <br />t <br />following: of the <br />a. The State of Florida Generic Permit for Stormwater Discharge From Lar <br />and Small Construction Activities (for projects one acre or larger), ge <br />b. The Stormwater Pollution Prevention Plan, <br />C. The St. Johns River Water Management District permit, <br />d• All other permits required for this project not specifically listed herein <br />e• All Codes and Ordinances of Indian River County. ,and <br />4. Permittee understands that "pollution" as defined by Florida Statutes <br />403.031(7) means: "... the presence in the outdoor atmosphere or waters atof th <br />of any substances, contaminants, noise, or manmade or human -induced impairmenta state <br />air or waters or alteration of the chemical, physical, biological, or radiological integrity <br />of <br />air or water in quantities or at levels which are or may be potentially harmful or injurio of <br />to human health or welfare, animal or plant life, or property or which unreason injurious <br />interfere with the enjoyment of life or property, including outdoor recreation ably <br />authorized by applicable law." unless <br />5. Permittee understands that in addition to the definition set forth in Item 4 <br />"pollution" is also defined by Florida Administrative Code 62-302.530 and s m <br />further defined in the Indian River County permit, as may be <br />6. Permittee understands that there are civil and criminal penalties forollut' <br />Florida Statutes Ch. 403.141 and Ch. 403.161 and that there are other enn listed t <br />Last revised: June 6, 2006 penalties listed <br />F:\Public Works\KefthM\Master FOrn1s\Permittee Affidavlt Regarding Pollution Leaving the Construction <br />Site.doc <br />