HomeMy WebLinkAboutFilled Land Affidavit PLANNING&DEVELOPMENT SERVICES DEP TME CEIVED
Building&Code Regulations Division
2300 VIRGINIA AVENUE Y i; d 9 0 9
FORT PIERCE,FL 34982-5652
(772)462-1553 ST. Lucie County, Permitting
FILLED LAND AFFIDAVIT
I,the undersigned, am the owner of the following described property,
c`�C>C95
LAk-V1—Wood 25 ( mig? 1,5111 4093791 -
(Parcel Id#/Legal description/Address) ��gG
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(Please Ppfnt) ct
Property Owner Signature Date
STATE OF FLORIDA,COUNTY OF -SFl l—V C NE`
ACKNOWLEDGED BEFORE ME—THIS 20t16 DAY OF V OE- 20
BY DIN 1D U, LAY 1 o N n WHO IS PERSONALLY KNOWN TO ME(_—)OR WHO HAS
PRODUCED PRI Y Q% L-A`W S F— AS IDENTIFICATION.
INA URE OF NOTARY PUBLIC TYPE OR PRINT NOTARY
5�OMMISSION NUMBER
(SEAL)
SLCPDSD Revised 04/11/2011 JOHN P.HUNT
.NCDTARY PUBLIq
STATE OF F%bRtDA
$, 12:
Comm#GG1115W
Expires 6/5/2021