HomeMy WebLinkAboutFilled Land Affidavit x - R �I PLANNING &DEVELOPMENT SERVICES DEPARTMENT
Building&Code Regulations Division
COUNTY
• R I D 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,
(Parcel Id#/Legal descripdon/Address)
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.
Property Owner Name(P ease Print)
Pr perry Owner Signature Date
STATE OF FLORIDA,COUNTY OF'q%-
ACKNOWLEDGED 1BEEFFORE ME THIS�_DAY OF�Q r e.mY.r 20 � 1 ,
B� Cj ►(�V (�1 CYC WHO IS PERSONALLY KNOWN TO ME(a OR WHO HAS
PRODUCEu.{%���, S_2.SD '14 E) ' y S O AS IDENTIFICATION.
C�
a )hA r a
SIG A4URE NOTARY PUBLIC TYPE OR PRINT NOTARY
"1 1 QI COMMISSION NUMBER
DAWN VAURIA
Notary Public,State of Florida
Commission#FF 170156
SLCPDSD Rcviscd 04/11/2011 m'Wrn,got"(7d.K I101e