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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 />Execute and attach the vacation rental regulations acknowledgement AttachedI Not Attached <br />form. <br />8. Application fee submitted: $250.00 <br />THE ABOVE INFORMATION AND STATEMENTS ARE TRUE TO THE BEST OF MY <br />KNOWLEDGE AND I WILL COMPLY WITH CHAPTER 911.15(9), LAND DEVELOPMENT <br />REGULATIONS OF INDIAN RIVER COUNTY, FLORIDA. <br />APPLICANT NAME (PRINT): <br />APPLICANT SIGNATURE <br />TE <br />STATE OF FLORIDA, COUNTY OF INDIAN RIVER SWORN AND SUBSCRIBED TO BEFORE <br />ME THIS DAY OF , 20 , WHO IS/ARE PERSONALLY <br />KNOW TO ME OR HAVE PRODUCED THEIR, <br />AND WHO DID NOT TAKE OATH: <br />NOTARY PUBLIC <br />STATE OF FLORIDA AT LARGE <br />MY COMMISSION EXPIRES: <br />_________FOR OFFICE USE ONLY========___________________ <br />DATE RECEIVED: DATE ACCEPTED: <br />PROJECT/APP REQ #: STVRL #: <br />REVIEWER: APPROVED: DENIED: BY: <br />EXPIRATION DATE: <br />Attachment 2 <br />FACOMMUNITY DEVELOPMENIWPLICATIONS\CODE ENFORCEMENT APPLICATIONS\VACATIONRENTALLICENSE.DOC 2 <br />P12 <br />