HomeMy WebLinkAboutFilled Lands Affidavit PLANNING & DEVELOPMENT SERVICES DEPARTMENT
c 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,
1302-810-0098-000-0 Lakewood Park addition Number 1 blocked lot 23
(Parcel ld#/Legal description/Address) -7To$ D®,040 )&,qp 1::7 IOKQ , rzoe lt 3 zm51
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.
Prop Owner Name lea a Print)
Pr4perty OwnJr at a to
STATE OF FLORIDA,COUNTY OF
ACKNOWLEDGED BrrFS
E,,F,JORE MME THIS DAY OF Tr2/ L. 120 q
BY QQ"A` K
� 2170tJ b V!C' WHO IS PERSONALLY KNOWN TO ME(_)5 WHO HAS
PRODUCED l-, iA _PZZ 141 X32 L I CG>-J 6'E AS IDENTIFICATION.
'V �(•l hfj L.G041�1
SIGNPUURE OF NOTARY PUBLIC TYPE OR PRINT NOTARY
goo(a 77qCOMMISSION NUMBER
(SEAL)
=o,PA�p°p Scott W.Malcom
State of Florida
SLCPDSD Revised 04/1 1/201 1 My Commission Expires 07/16/2019
"Q Commission No.FF 900679