HomeMy WebLinkAboutFilled Land Affidavit •
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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 undeer�rsi`gned, am the owner of the following described property,
(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.
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Propgty Owner Name(Please Print)
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Property Owner Signature Date
STATE OF FLORIDA,COUNTY OF
ACKNjOWLE(DDG�EDDBBEF/(RE ME THIS - DAY OF / �"`� 1 120 ,
BY 1�t yw / WHO IS PERSONALLY KNOWN TO ME(a OR WHO HAS
PRODUCED Dl,f ✓(/' ` ! "' AS IDENTIFICATION.
hGNrT'URE OF NOTARY TYPE OR PRINT NOTARY
COMMISSION NUMBER '
(SEAL)
W LASHAHNA INGRAM
SLCPDSD Revised 04/1112011 s;
Notary Pcblic-State of Florida
My Comm. Expires Dec 20,2018
Commission # FF 177249
trough Nai-al Notary Assn.