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�ti`.}ER INDIAN RIVER COUNTY DEPARTMENT OF UTILITY SERVICES PRELIMINARY PETITION FORM �oie►�` PROPOSED WATER MAIN ASSESSMENT— Winter Beach Park & Portion of Winter Beach Highlands 5111 Avenue from 65th St to 691h St Parcel No: 32390900003000000011.0 Site Address: 6570 51ST AV Owner Name: WARREN, JAMES T and PRISCILLA L Mailing Address: JAMES'T and PRISCILLA L, WARREN 6570 51ST AVE VERO BEACH, FL 32967 Legal Description: WINTER BEACH HIGHLANDS LOT 111313116-58 *Please sign & return* This proposed water main assessment project will be completed as an equal -share assessment, below is the amount your property will be assessed base on Indian River County's construction cost: Assessment (Construction) Cost per Lot: $9,400.00 Based.on the information packet you have received for the proposed water assessment project, please check one of the options below and return to Indian River County Department of Utility Services. ' YES - In favor of the proposed Water Assessment Project. NO — Not in favor of the proposed Water Assessment Project. The undersigned petitioner respectfully requests the Board of County Commissioners of Indian River County (the "County") undertake measures to establish a Water Assessment Program ("Project") pursuant to Ordinance 81-27 (the "Ordinance"), as more particularly set forth, shown, proposed and agreed hereafter. �).'Ai ` o Signature: Owner . Date: Signature: Secondary Owner Date: Signature: Trust Date: NOTE: Please Review Signature: Trust Date: 1. Properties under a trusts you must provide the trust document and or the warranty deed, only the person/persons who are authorized to sign or the Trustee can sign the petition. If there are multiple Trustees, then all have to sign the petition. 2. Property 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. 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. Indian River County — Utility Department will not move forward unless 66.7% majority is in favor of the project and the three requirements listed above are met. This petition must be received by Indian River County Department of Utility Services by December 31, 2019. Late petitions may be counted as "Not in Favor." 118