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PLANNING&DEVELOPMENT SERVICES DEPARTMENT
Building&Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE,FL 34982-5652
(772)462-1553 RECEIVED
FILLED LAND AFFIDAVITF ,JUL 01 2019
ST. Lucie County, Permitting
I,the undersigned, am the owner of the fo110 ing described property,
(Parcel Id#/Legal description/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.
�e S►cow. �Yl
Property Owner Name(Please P '
p� Owner Signature Date
STATE OF FLORIDA,COUNTY OF
ACKN D BEFORE ME THIS DAY OF 20
BY .S JCA WHO IS PERS LY KNOWN TO N E(, )OR WHO HAS
PRO C_ ,AS IDENTIFICATION.
SIGNATURE O OTARY PUBLIC YPE OR PRINT NOTARY
COMMISSION NUMBER
(SEAL)
i
SLCPDSD Revised 04/11/2011AUDREY B.HUMPHREY
GG
" MY COMMISSION# 3008172023
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