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5. Unit is served by (check one): Public sewer: On-site septic/drainfield system: <br />Note: If served by an on-site sewage treatment and disposal system, the applicant is required to <br />provide an existing system evaluation approved by the Health Department if the Health Department <br />has no record of the system size permitted by the department. Code Enforcement will contact you if the <br />Health Department has no record of the system size. <br />6. Total Number of bedrooms: <br />Square footage of each bedroom: <br />A"' <br />. <br />7. Execute and attach the vacation rental regulations acknowledgement AttachedI Not Attached <br />s< <br />form. - «� .�;I <br />8. Application fee submitted: $250.00 <br />=FORZO PENCE USE <br />THE ABOVE INFORMATION ANDS TATE <br />KNOWLEDGE AND I WILL COMPLYVTH < <br />REGULATIONS OF IND I _'RIVER COUNTY <br />" z VIM. <br />APPLICAT NAME (PR<INT): <br />E aTRUE TO THE BEST OF MY <br />91 15(9), LAND DEVELOPMENT <br />APPLICANT SIGNATURES . Y���� DATE <br />C gq <br />,�°. <br />STATEOFFLORIDA,,, O�UNTYOFW. <br />INDIAN'WRIMER SWORN AND SUBSCRIBED TO BEFORE <br />ME THIS:'k Mt-WOF , 20—, WHO IS/ARE PERSONALLY <br />�w <br />KNOW TO: ME OR HAVE PRODUCIDHEIR, <br />AND WHO DID NU,T TAKE OATH: <br />NOTARY PUBLIC ' <br />STATE OF FLORIDA AT LDAP <br />MY COMMISSION EXPIRES: <br />Attachment 16 <br />F -\COMMUNITY DEVELOPMENTAPPLICATIONS\CODE ENFORCEMENT APPLICATIONS\VACATIONRENTALLICENSE.DOC 2 224 <br />