HomeMy WebLinkAboutFilled Land Affidavit PLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building& Code Regulations Division
Me.410119 1
• 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,
1 0 �d0 016( 3 — D00 -`7
(Parcel I0/Legal description/Address)
for which I have applied to St. Lucie County for a Final Development Permit. III
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(Please Print)
Property Owner Signature Date
I �
STATE OF FLORIDA,COUNTY OF -
ACKNOWLEDGED BEFORE ME THIS / DAY OF 20 I
BY c.`�.l A �(�" WHO IS PERSONALLY KNOWN TO ME(K OR WHO HAS
t
PRODUCED ,Q/ t C AS IDENTIFICATION.
SIG UROF NOTARY PUB I TYPE OR PRINT NOTARY
I9 L?! OMMISSION NUMBER t Erich Daniel Krach
�S�Yo
T,41�Y PUBLIC
ATE OF FLORIDA
Comm#GG1175925
�Nce I9�� Expires 5/17/2021
SLCPDSD Revised 04/11/2011