HomeMy WebLinkAboutFilled Land Affidavit �.T_._ PLANNING&DEVELOPMENT SERVICES DEPARTMENT'
o `' Building&Code Regulations Division
2300 VIRGINIA AVENUE _
FORT PIERCE,FL 34982-5652FA
T-
(772)462-1553
FILLED LAND AFFIDAVITy, Permitting
I,the undersigned, am the owner of the following described property,
zin EAC-N%4
(Parcel Id#/Legal descri tion/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.
Property Owner Name lease
Property er Signature Date
STATE OF FLO COUNTY OF-- CL
F -LR. of "C-i
ACKNOWLEDGED BEFORE ME - DAY OF f Ty J�� 20 %
BY t-41 S e''-v ci--T WHO Is PERSONALLY KNOWN TOME OR WHO HAS
PRODUCED"be-Iv A 5 1—t Cin S S 3 Q?i" -5S( 5S—J WS—U AS IDENTIFICATION.
SIG ATURE OF NOTARY PUBLIC TYPE OR PRINT NOTARY
COMMISSION NUMBER
CATHCRWBT)iOMSON
MY COMMISSION.#FF976760
EXPIRES:MAR 29,2020
Banded through 1st State Insurance
SLCPDSD Revised 04/11/2011