HomeMy WebLinkAboutFilled Land Affidavit f
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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,
0 3 atL:Ier�
(Parcel Id#/Legal description/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.
�r tj ce- y P rS c h l-Q,-A
Property Owner Name f(PIease Print)
Property Owner Signature Date
STATE OF FLORIDA,COUNTY O
ACKNOWLEDGED BEFORE ME THIS
,L� DAY OF 20
BY r�j "EJ IVHO IS PERSONALLY KNOWN TO ME L—)OR WHO HAS
PRODUCED / 1 '`Of f,A AS IDENTIFICATION.
SIGNATURE OF N Y PUBLI TP OR PRINT NOTARY
OMMISSION NUMBER
(SEAL)
.'"W.,Fpj AUDREY B.HUMPHREY
MY COMMISSION#FF 174772
SLCPDSD Revised 04/11/2011 L,•4..„ EXPIRES:March 6,2019
?IjrR . Bonded Thru Notary Public Underwriter;