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7. APPLICANT AFFIRMATION:
<br />Application is hereby made for a Miami -Dade County Class V permit to authorize the activities described herein. I agree to or affirm
<br />the following:
<br />• 1 possess the authority to authorize the proposed activities at the subject property, and
<br />• 1 am familiar with the information, date and plans contained in this application, and
<br />• To the best of my knowledge and belief, the information, data and plans submitted are true, complete and accurate, and
<br />• 1 will apprise the Department of any changes to information provided in this application, and
<br />• 1 will provide any additional information, evidence or data necessary to provide reasonable assurance that the proposed
<br />project will comply with the applicable State and County water quality standards both during construction and after the project
<br />is completed, and
<br />• 1 am authorizing the permit agent listed in Section 4 of this application to process the application, furnish supplemental
<br />information relating to this application and bind the applicant to all requirements of this application, and
<br />• 1 agree to provide entry to the project site to inspectors and authorized representatives of Miami -Dade County, with proper
<br />identification or documents as required by law, for the purpose of preliminary analysis, verification, sampling, monitoring, and
<br />observation of permitted activities.
<br />A. IF APPLICANT IS AN INDIVIDUAL
<br />Signature of Applicant
<br />Print Applicant's Name
<br />B. IF APPLICANT IS OTHER THAN AN INDIVIDUAL OR NATURAL PERSON
<br />(Examples: Corporation, Partnership, Trust, LLC, LLP, etc.)
<br />Print Name of Applicant (Enter the complete name as registered) Type (Corp, LLC LLP, etc.)
<br />Date
<br />State of Registration/Incorporation
<br />Under the penalty of perjury, I certify that I have the authority to sign this application on behalf of the Applicant, to bind the
<br />Applicant, and if so required, to authorize the issuance of a bond on behalf of the Applicant. (If asked, you must provide
<br />proof of such authority to the Department). Please Note: If additional signatures are required, pursuant to your governing
<br />documents, operating agreements, or other applicable agreements or laws, you must attach additional signature pages
<br />(ATTACHMENT "A").
<br />Signature of Authorized Representative Print Authorized Representative's Name Title
<br />Date
<br />C. IF APPLICANT IS A JOINT VENTURE Each party must sign below (If more than two members, list on attached page)
<br />Print Name of Applicant (Enter the complete name as registered)
<br />Print Name of Applicant (Enter the complete name as registered)
<br />Type (Corp, LLC LLP, etc.) State of Registration/Incorporation
<br />Type (Corp, LLC LLP, etc.) State of Registration/Incorporation
<br />Under the penalty of perjury, I certify that I have the authority to sign this application on behalf of the Applicant, to bind the
<br />Applicant, and if so required to authorize the issuance of a bond on behalf of the Applicant. (If asked, you must provide
<br />proof of such authority to the Department). Please Note: If additional signatures are required, pursuant to your governing
<br />documents, operating agreements, or other applicable agreements or laws, you must attach additional signature pages
<br />(ATTACHMENT "A").
<br />Signature of Authorized Representative Print Authorized Representative's Name Title Date
<br />Signature of Authorized Representative Print Authorized Representative's Name Title Date
<br />Class V Permit Application Form Page 2 of 7 (Rev 09/24)
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