HomeMy WebLinkAboutFilled Land Affidavit J
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
' Building &Code Regulations Division _
2300 VIRGINIA AVENUE RECEIVED
FORT PIERCE,FL 34982-5652
(772)462-1553
MAR 01 2018
FILLED LAND AFFIDAVIT ST. Lucie County, Permitting
I,the undersigned, am the owner of the following described property,
I1. 06 5a 00 (� . 9
(Parcel d#/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.
1,�I �"n C S C .
Property Pwner Name(Please Print)
Prop Own�d Signature Date
STATE OF FLORIDA,COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OF \ \ 1WYYd--� '2017
BY Ali.. S (22 1 V � WHO IS PERSONALLY KNOWN TO ME Q)OR WHO HAS
PRODUCED AS IDENTIFICATION.
SIGNATURE OF NOT UBLIC TYPE OR PRINT NOTARY
COMMISSION NUMBER
S
KAREN S. NIELSEN
P
Commission k FF 115637
My Comnussion Expires
SLCPDSDRevised 04/11/2011 ' June 12, 2018