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INDIAN RIVER COUNTY DEPARTMENT OF UTILITY SERVICES <br />PRELIMINARY PETITION FORM <br />PROPOSED WATER MAIN ASSESSMENT— Winter Beach Park & Portion of Winter Beach Highlands <br />5111 Avenue from 651h St to 691h St <br />Parcel No: 32390900003000000006.0 <br />Site Address: 6636 51ST AV <br />Owner Name: PAVLIK, FRANCIS J (LE) & ALEXANDER M <br />Mailing Address: <br />FRANCIS J (LE), ALEXANDER M PAVLIK <br />5706 38TH ST <br />VERO BEACH, FL 32966 <br />Legal Description: <br />WINTER BEACH HIGHLANDS LOT 6 PBI 6-58 *Please sign & return* <br />This. proposed water main assessment project will be completed as an equal -share assessment, below is the amount your <br />property will be assessed base on Indian River County's construction cost: <br />Assessment (Construction) Cost per Lot: $9,400.00 <br />Based on the information packet you have received for the proposed water assessment project, please check one of the options <br />below and return.to Indian River County Department of Utility Services. <br />YES - In favor of the proposed Water Assessment Project. <br />NO — Not in favor of the proposed Water Assessment Project. <br />The undersigned petitioner respectfully requests the Board of County Commissioners of Indian River County (the "County") <br />undertake measures to establish a Water Assessment Program ("Project") pursuant to Ordinance 81-27 (the "Ordinance"), as <br />more particularly set forth, shown, proposed and agreed hereafter. <br />Signetu e: � ner Date: Signature -...Secondary Date: <br />Signature: Trust Date: Signature:. Trust Date: <br />NOTE: Please Review <br />1. Properties under a trust: you must provide the trust document and or the warranty deed, only the person/persons who are authorized to sign or the Trustee can <br />sign the petition. if there are multiple Trustees, then all have to sign the petition. <br />2. roperty•under multiple ownership A minimum of 51% must sign the petition. Example: If two then both need to sign. If three then two need to sign. <br />3. Property under husband & wife without secondary owners filled out (Property Appraiser's Site: ) Then one signature either from the husband or wife is adequate. <br />Indian River County— Utility Department will not move forward unless 66.7% majority is in favor of the project and the three requirements listed <br />above are met. This petition must be received by Indian River County Department of Utility Services by December 31, 2019. Late petitions may <br />be counted as "Not in Favor." <br />113 <br />