HomeMy WebLinkAboutFilled Land Affidavit i
I
I
I
PLANNING&DEVELOPMENT SERVICES DEPARTMENT
Building&Code Regulations Division
• 2300 VIRGINIA AVENUE
FORT PIERCE,FL 34982-5652
(772)462-1553 ✓ �Cfi��
FILLED LAND AFFIDAVIT psi 9a ezo��
�'bdr I
I,the undersigned, am the owner of the following 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 Ia 6"7-011 , 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 Na (Please Print)
Property Owner Signature Date
i
STATE OF FLORIDA,COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OF 20—Li—
BY '
BY C(x H 'OE"Q WHO IS PERSONALLY KNOWN TO ME L_)OR WHO HAS
PRODUCED 'L AS IDENTIFICATION.
SIGNATURE OF NOTA 95 PUBLIC TYPE OR PRINT NOTARY
C� -fn o() 10MMISSION NUMBER
(SEAL)
i
P�a,,, ELLELorn('
GHN
State of Flery Public
Commiss270079SLCPDSD Revised 04/11/2011My ComExpiresOcto022-