HomeMy WebLinkAboutFilled Land Affidavit PLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division
' 2300 VIRGINIA AVENUE
FORT PIERCE,FL 34982-5652
(772)462-1553
FILLED LAND AFFIDAVIT
i
I,the undersigned, am the owner of the following described property,
(Parcel I NLegal desc?$tion/Address)
for which I have applied to St. Lucie County for a Final Develo ment Permit. In
accepting this Final Development Permit, BP Number — ' F , 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.
D9v14 c. LX nr e_ -rte
Property Owner Name(Please Pr nt)
Pro erty Owner Signature Date
STATE OF FLORIDA,COUNTY OF ��,M-C
ACKNOOWLEDGEfD BEFORE ME THIS 3Z
Z—DAY OF a)e C� 12 >
� L
BY � 1p e roy WHO IS PERSONALLY KNOWN TO ME([4 OR WHO HAS
PRODUCED 1 L— r AS IDENTIFICATION.
SIGNATURE OF NOVARY PUBLIC TYPE ORPRINT N TARY
Va ()Ml,COMMISSION NUMBER
ap7ARrpi
Stare F<<
�c
cO� of
My o,ss�o'ae q�G
SLCPDSD Revised 04/11/2011 S o�G,2"o
r,
I
i
I �