HomeMy WebLinkAboutFilled Land Affidavit Jul 23 1912:12p John Rodgers Concrete 772-46573827 p.1
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PLANNING&DEVELOPMENT SERVICES DEPARTMENT
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,
3V c,:;, - �o / c- 035--D - 000- ?'
(Parcel IM/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.
Property Owner Name(PIease Print)
4nQ_��� • '� /224 t
Property Owner Signature Date
STATE OF FLORIDA,COUNTY OF cu• Lac%
ACIC40WLEDGED BEFORE ME THIS -2�2 DAY OF Lt 20
BY ��( e M —4)4 I Sem WHO IS PERSONALLY KNOWN TOME(1])OR WHO HAS
ODUCED AS IDENTIFICATION.
SIG/�NATLTR . OTARY PUBLIC TYPE OR PRINT NOTARY
CY
6001 CONEMISSION NUMBER
JENNIFEF.SWEET (SE )
NctaryPublic-S?aleofFarida
Commission&GG 50011
MyComm.b imsJan29,2021
SLCPDSD Revised 04111/2011