HomeMy WebLinkAboutFilled Land AffidavitPLANNING & DEVELOPMENT- SERVICES DEPARTMENT
Building & Code. Regulations Division 1
• 2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772) 462-1553
FILLED LAND AFFIDAVIT
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I, the undersigned, am the owner of th following desc ibed property,
(Pareel Id#/Legal description/Address) III
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 r,, sponsible for assuring
adequate drainage so that the immediate community WILL NOTI I' 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, orlnaintain in any form,
adequate drainage off my .property which will not adversely! 11affect the immediate
community. j
Property Owner Name (Please Print),I
6_ezyv-� Q /_7
Property er Signature Date
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STATE OF FLORIDA, COUNTY OF �WC�
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ACKN EDGED B F THIS DAY OF � IIS � , 20
BY O IS PERSONALLY KNOWN TO MEOR WHO HAS
PRODUCED
�+�i i AS IDE TIFICATION.
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SIGNATURE OF NO ARY PUBLIC KEO RINT NOTARY II
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OMMISSION NUMBER
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(SEAL)
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SLCPDSD Revised 04/11/2011,oiPa$ PO%,� ANGELA M HUFF
_ * „ Notary Public - State of Florida=.' �_ ' Commission # FF 234730
%"r9T hoc My Comm. Expires May 27,2019
Bonded through National Notary Assn. t 1
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