HomeMy WebLinkAboutFilled Land Affidavit PLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division
• 2300 VIRGINIA AVENUE
FORT PIERCE,FL 34982-5652
(772)462-1553
FILLED LAND AFFIDAVIT
I,the undersigned, am the owner of the following described property,
01A06 cj4(, ►/fij r2CL e5r ,XT IffPCE , FLA 3O15l
(Parcel I&ILegal description/Ad`d'ress)
for which I have applied to St. Lucie County for a Final Development Permit. In
accepting this Final Development Permit, BP Number , I acknowledge
that as owner of the above described property, and in accordance with Section
7.04.01(D), St.Lucie County Land Development Code, I shall be responsible for assuring
adequate drainage so that the immediate community WILL NOT be adversely affected.
I further acknowledge that in granting this permit for the development of this property,
St. Lucie County is neither obliged nor liable to provide for, or maintain in any form,
adequate drainage off my property which will not adversely affect the immediate
community.
RE /414 rvl,-
Property/ wn r a e(Please Print)
Z7 7
Prope Owner Signature Date
STATE OF FLORIDA,COUNTY OF
ACKNO DGED BEFORE ME THIS DAY OF a46 20�
BY ICAC . ��"�'!U���j Y-" WHO IS PERSONALLY KNOWN TO ME L OR WHO HAS
PRODUCED AS IDENTIFICATION.
SIGNATURE OF ARY PUB TI OR PRINT NOTARY
COMMISSION NUMBER
(SEAL)
SLCPDSD Revised 04/11/2011
Y�P�B r. AUDREY 8.HUMPHREY
'r4 ` MY COMMISSION#FF 174772
EXPIRES:March 6,2019
'%� �� Bonded Thru Notary Pu61ic Underwrders
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