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cyW PF9�[fII FLORIDA ON NOTICE OF INTENT TO USE THE GENERAL PERMIT FOR CONSTRUCTION OF WATER MAIN EXTENSIONS FOR PWSs INSTRUCTIONS: This notice shall be completed and submitted by persons proposing to construct projects permitted under the "General Permit for Construction of Water Main Extensions for Public Water Systems" in Rule 62-555.405, F.A.C. AT LEAST 30 DAYS BEFORE BEGINNING CONSTRUCTION OF A WATER MAIN EXTENSION PROJECT, complete and submit one copy of this notice to the appropriate Department of Environmental Protection District Office or Approved County Health Department (ACHD) along with payment of the proper permit processing fee. (When completed, Part II of this notice serves as the preliminary design report for a water main extension project, and thus, it is unnecessary to submit a separate preliminary design report or drawings, specifications, and design data with this notice.) All information provided in this notice shall be typed or printed in ink. The permit processing fee for projects requiring the services of a professional engineer during design is $250, and the permit processing fee for projects not requiring the services of a professional engineer during design is $100.* Checks for permit processing fees shall be made payable to the Department of Environmental Protection or the appropriate ACHD. NOTE THAT A SEPARATE NOTIFICATION AND A SEPARATE PERMIT PROCESSING FEE ARE REQUIRED FOR EACH NON-CONTIGUOUS PROJECT.' * Except as noted in paragraphs 62-555.520(3)(a) and (b), F.A.C., projects shall be designed under the responsible charge of one or more professional engineers licensed in Florida. t Non-contiguous projects are projects that are neither interconnected nor located nearby one another (i.e., on the same site, on adjacent streets, or in the same neighborhood). 1. General Project Information A. Name of Project: Oslo Road/Lateral 'J' Bridge Replacement B. Description of Project and Its Purpose: Relocation of existing 20" WM to accommodate the proposed bridge -culvert. C. Location of Project 1. County Where Project Located: Indian River 2. Description of Project Location: Sections 24 & 25, Township 33S, Range 39E D. Estimate of Cost to Construct Project: $120,000 E. Estimate of Dates for Starting and Completing Construction of Project: 5/1/05 — 7/1/05 F. Permittee PWS/Company Name: Indian River County PWS Identification No.:* 3314052 PWS Type:* ® Community ❑ Non -Transient Non -Community ❑ Transient Non -Community ❑ Consecutive Contact Person: Gordon Sparks Utility Department Contact Person's Title: Environmental Engineer Contact Person's Mailing Address: 1840 25th Street Contact Person's Title: Environmental Engineer City: Vero Beach 1840 25`h Street State: FI Zip Code: 32960 Contact Person's Telephone Number: 772-567-8000 Contact Person's Fax Number: 772-770-5143 Contact Person's E -Mail Address: gsparks@ircgov.com * This information is required only if the permittee is a public water system (PWS). G. Public Water Svstem (PWS) Sur)plvinR Water to Project PWS Name: North County & South County Ro Water Plants PWS Identification No.: 3314052 PWS Type: ® Community ❑ _ Non -Transient Non -Community ❑ Transient Non -Community ❑ Consecutive PWS Owner: Indian River County Utility Department Contact Person: Gordon Sparks Contact Person's Title: Environmental Engineer Contact Person's Mailing Address: 1840 25`h Street City: Vero Beach Contact Person's Telephone Number: 772-567-8000 _ State: Fl Zip Code: 32960 Contact Person's Fax Number: 772-770-5143 Contact Person's E -Mail Address: gsparks@ircgov.com DEP Form 62-555.900(7) Page I Effective August 28, 2003