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Indian River County Department of Utility Services <br />Official Survey Form <br />Proposed Water Main Assessment Aerodrome <br />Subdivision <br />33382300002000000009.0 <br />THEISS WINNIE C f}1{4 aI/age Da�� <br />100 NIEUPORT DR <br />Signature Date <br />Signature <br />Based upon the information provided on November 24th, 2013: <br />Check one: <br />Date <br />YES -In favor of The Indian River Aerodrome Water <br />Assessment Project. <br />NO -Not in favor of The Indian River Aerodrome Water <br />Assessment Project. <br />Please make three (3) copies. One for yourself ,one for the HOA & send <br />one the Utility Department @ the address below. <br />Please mark your choice and return in the envelope provided no later <br />than Monday December 16, 2013. <br />Return Survey to: <br />Indian River County Utilities Department <br />ATTN: Assessment Coordinator -Aerodrome <br />1801 27th Street <br />Vero Beach, FL 32960 <br />Please call (772) 226-1821 if you have any questions. <br />96 <br />