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in Indian River County's permits, including but not limited to, Indian River County issuing <br />a Cease and Desist Order for the project. Permittee understands that it may be liable <br />for these and other penalties if pollution occurs as a result of its activities associated D <br />with the Project. <br />Under penalty of perjury, Permittee declares that it has read the foregoing affidavit and the <br />facts stated in it are true. <br />FURTHER AFFIANT SAYETH NAUGHT <br />Permittee: <br />M1 <br />Gl�tdl <br />Authorized Signature: <br />11;q Co 0-e- <br />/ (If signing as Owner's Agent, attach Letter of Authorization to Sign from Owner) <br />Printed Name: _/��� �dNS'/� J � I) <br />Date: <br />The foregoing instrument was subscribed and s <br />Cc- -I We A , 206S by 101 (C' H/ -i &&- <br />who is personally known to me or has produced <br />identification and who did take oath. <br />My Commission expires: <br />Last revised: June 6, 2006 <br />rn t before me this is day of <br />P,1q <br />C. <br />Notary Public State of Florida at Large <br />�` :"• � BRENDA 0. HOW <br />* * MY COMMISSION # DD 627845 <br />EXPIRES: January 13, 2011 <br />')'�oF W Bonded Tlxu Budget Notary services <br />2 <br />FAPublic Works\KeithM\Master Forms\Permittee Affidavit Regarding Pollution Leaving the Construction Site.doc <br />as <br />