HomeMy WebLinkAboutFilled Land Affidavit i
PLANNING&DEVELOPMENT SERVICES DEPARTMENT
Building&Code Regulations Division
• 2300 VIRGINIA AVENUE
FORT PIERCE,FL 34982-5652
(772)462-1553 RECEIVED _
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FELLED LAND AFFIDAVIT
DEC 2 7
ST. Lucie county, Permitting
I,the undersigned, am the owner of the following described property,
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�3zo soy o1i24 010 4 24bs $irockSM� h Rd Fr P, E41 F1
(Parcel IM/Legal description/Address)
for which I have applied to St. Lucie County for a Final Development Permit. In ;
accepting this Final Development Permit, BP Number , I acknowledge
that as owner of the above described property, and in accordance with Section
7.04.01(D), St.Lucie County Land Development Code,I shall be responsible for assuring
adequate drainage so that the immediate community WILL NOT be adversely affected.
I further acknowledge that in granting this permit for the development of this property,
St. Lucie County is neither obliged nor liable to provide for, or maintain in any form,
adequate drainage off my property which will not adversely affect the immediate
community.
Property Owner Name(Please Print)
0 6."� l
operty Owner Signature Date
STATE OF FLORIDA,COUNTY OF ��
ACKNOWLEDGED BEFORE ME THIS \ -\ . DAY OF }�p� ,20 q
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BYY ��L ���fl WHO IS PERSONALLY KNOWN TO ME!1 X Il OR WHO HAS
PRODUCED AS IDENTIFICATION.
SIGNATUREPV ARY PUBLIC T OR PRWr NOTARY
C �1loZS COASUSSION NUMBER
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A4916"rr13 ,ANGELA LEE-CARTER
- Cohtlfibn#GG 017675
Expires September 13,2020
=y?° R"••' Bonded Tlw Troy Fem Insurance$M4*7019
SLCPDSD Revised 04/11/2011
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