HomeMy WebLinkAboutFilled Land Affidavit PLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building&Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE,FL 34982-5652 IZSCS
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(772)462-1553
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FILLED LAND AFFIDAVIT Depa�me�t
Per Sr L9�e GoOX\
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I,the undersigned, am the owner of the following described property, j
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(Parcel Id# egal description/address)
10-7aS s OcR-o. -D r --�g 4SQ Jensen FL_ 3t14s�
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.
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Property Owner Name(Please Print)
Property er ign a Date
STATE OF FLORIDA,COUNTY OF ST LV L1 9-
ACKNOWLEDGED
ACKNOWLEDGED BEFORE ME THIS DAY OF '--�>�-O�'5M 1K 1Z /9
BY M14elF/-tia b V Y70/) b WHO IS PERSONALLY KNOWN TOME )OR WHO HAS
PRODUCED FL � 1.1 Vfv45 6--o—Y!t- D I2c7-559-W-?//-'OAS IDENTIFICATION.
SIGNATURE OF NOTARY PUBLIC TYPE OR PRINT NOTARY
36-( COMMISSION NUMBER
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�+IE Notary Public State of Florida
N. Brian S Commission
My Commission GG 252301 �
Expires 12/23/2022
SLCPDSD Revised 04/l 1/2011O�
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