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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, b�'fz<g L CVF [ q zs 7©l (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. 1A�A E I I Ea- Property Owner Name(Please Print) Property Owner Signature Date STATE OF FLORIDA,COUNTY OF LtA Q 1 U_ CCU f `� ACKNOWLEDGED BEFORE ME THIS DAY OF tr I / 20j BYE�Tl� p.r/�rn PLIFIlLe WHO Is PERSONAW ILLY KNAN TOME CE-1ORWHO HAS PRODVol� l J v e Nom+ ) �/ 'C AS IDENTIFICATION. SIGNATURE OF U TARY PUBLIC YPE OR PRINT NOTARY COMMISSION NUMBER (SEAL) SLCPDSD Revised 04/11/2011 ,sr dy'., W. T, AWREYa.HUMPHREY MY COMMISSION 1f FF EXPIRES:March 6,20192 Bonded Thru Nota Pubic Unde ry rwriters