For Office Use Only __Permit/Project Number 201___-. errebonne Parish Consolidated Government Department of Planning & Zoning RECREATIONAL VEHICLE AFFIDAVIT RECREATIONAL VEHICLES SHALL NOT BE USED AS PRIMARY RESIDENCE. RECREATIONAL VEHICLES SHALL NOT BE PLACED IN MOBILE HOME PARKS. com, ded. ‘The undersigned does hereby attest and certify that the following information is true and correct. 1am applying for a permit in Terrebonne Parish for the placement of a recreational vehicle on certain parcel of immovable property bearing the municipal address of J understand that the Terrebonne Parish Code, Section 9-57, Subsection 5, requires that recreational vehicles placed on sites within zones A1 30, AH, and AE on the community's FIRM (i) be on the site for fewer than one hundred eighty (180) consecutive days; and, (ii) be fully licensed and ready for highway use. A recreational vehicle is ready for highway use if tis on its wheels or jacking system, is attached to the site only by quick disconnect type utilities and security devices, and has no permanently attached additions. AlL (initial each blank.) I certify that my recreational vehicle is NOT a mobile home or former FEMA temporary housing, unit; and I understand that, under the Louisiana State Uniform Construction Code (LA RS 40.-§1730), a recreational vehicle or FEMA temporary housing unit. i is Junderstand that any permitissued for a recreational vehicle is valid only for one hundred eighty (180) days as specified in the Terrebonne Parish Consolidated Building Code. nts withi i in: (Initial each blank) —_ certify that the recreational vehicle will be on the site for fewer than one hundred eighty (180) consecutive days. certify that the recreational vehicle is and will remain fully licensed and ready for highway use. Itis onits wheels or a jacking system, will be attached to the site only by quick disconnect type utilities and security devices, and will have no permanently attached additions. General Information: By signing this form, the applicant understands that the intentional act of submitting false information toa public agency may constitute a violation of applicable provisions of the Louisiana Criminal Code, subjecting the person making the false statement to imprisonment up to five (5) years, a fine up to $5,000, and/or restitution to the state including legal interest. (LA RS 14: 133), ‘This form must he. ‘somplsted, notarized and uploaded with your permit application! Sworn to and subscribed on this date of. 0 ‘Signature of Applicant Print Name Notary Public, Parish of, State of Louisiana Notary ID Number My Commission Expires