HomeMy WebLinkAboutfilled land Affidavit PLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building&Code Regulations Division
2300 VIRGINIA AVENUE ^
FORT PIERCE,FL 34982-5652 t J1
(772)462-1553
FILLED LAND AFFIDAVIT 05&
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1, the undersigned, am the owner of the following described property, pe R Og Z0�
1312-801-0143-000-4 ( 5101 Paleo Pines Cir, ft.pierce fl 34951 Sr. �vCe°eaa,�
(Parcel Id#/Legal description/Address) �Y
for which I have applied to St. Lucie County for a Final Development Permit. In
accepting this Final Development Permit, BP Number 1803-0564 , 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.
Brian C grothe
Prop er Namf,fPlease Print)
4/8/18
Property Owner Signature Date
STATE OF FLORIDA,COUNTY OF St.lulce County
ACKNOWLEDGED BEFORE ME THIS 4 DAY OF 8 2018
BY BRlan C grothe WHO IS PERSONALLY KNOWN TO M£(Ia OR WHO HAS
PRODUCED _ __ _ AS IDENTIFICATION.
I
Juan Moran
SIGNAT OF NOTARY PbMIC TYPE OR PRINT NOTARY
19562 COMMISSION NIJMBER
(SEAL)
SLCPDSD Revised 04/11/2011 =o rer.r��n JUAN MORAN
MY COMMISSION#GGO19562
EXPIRES:AUG 09,2020
" Bonded through 1st State Insurance