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PERMITTEE'S AFFIDAVIT REGARDING POLLUTION <br /> This sworn statement is submitted to Indian River County for the following project (list <br /> project name and site address): <br /> STATE OF <br /> COUNTY OF <br /> Personally before me the undersigned authority, appeared <br /> , who upon oath duly <br /> administered, stated as follows: <br /> 1. This sworn statement is submitted bythe PERMITTEE, <br /> , <br /> whose business address is <br /> and (if applicable) its Federal Identification No.(FEIN) is <br /> 2. My name is and my relationship to the <br /> entity named above is <br /> (If signing as Owner's Agent, attach Letter of Authorization to Sign from Owner) <br /> 3. Permittee understands and agrees that in addition to complying with the terms and <br /> conditions of the Stormwater Management System Permit issued by Indian River <br /> County, Permittee is responsible for complying with the terms and conditions of the <br /> following as applicable to the site: <br /> (a) State of Florida Generic Permit for Stormwater Discharge From Large and Small <br /> Construction Activities (for projects one acre or larger), <br /> (b) Stormwater Pollution Prevention Plan (regardless of project size), <br /> (c) St. Johns River Water Management District permit(s) (regardless of project size), <br /> (d) Florida Department of Environmental Protection permit(s) (regardless of project <br /> size), <br /> (e) All other permits required for this project not specifically listed herein, and • <br /> (f) All Codes and Ordinances of Indian River County. <br /> 4. Permittee understands and agrees that "pollution" as defined by Florida Statutes <br /> Chapter 403.031(7) includes: ". . . the presence in the outdoor atmosphere or waters of <br /> the state of any substances, contaminants, noise, or manmade or human-induced <br /> Last revised:6/29/2018 1 <br /> \public works\engineering division projects\1760 victor hart sr.complex drainage improvements\1-admin\bids\bid documents\irc- <br /> 1760_appen_c 20180813.doc <br />