HomeMy WebLinkAboutFilled land affidavit ri
PLANNING&DEVELOPMENT SERVICES DEPARTMENT
eM Ta TIE M
. 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,
(Parcel Id#/Legal description/Address)
I
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,
j 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(Plea/se Print)
,h' '1 v (lfat"y .Sly. ��
operty Owner Signature Date
STATE OF FLORIDA,COUNTY OF 5t
ACKNOWLEDGED BEFORE ME TIES. DAY OF ?Ip 20_Ii�
1
BY `` 0'�on�^s {`�``�,� 'f �� WHO IS PERSONALLY KNOWN TO ME([I)OR WHO HAS
PRODUCED V`L y/�^ AS IDENTIFICATION.
bon
SIGNATURE OF NOTAWJUBLIC TYPE OR PRINT N
coMMlssloN NUMBER 0 ��:"Jtr, ELLEN VA U G H N
���4PRY AU�I��
2State of Florida=Notary Public
Commission #GG 270078
=" My Commission Expirea
O{"p Oetebor 22 992 .
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SLCPDSD Revised 04/11/2011
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