HomeMy WebLinkAboutFilled Lands Affidavit- - PLANNING & DEVELOPMENT SERVICES DEPARTMENT
' - Building & Code Regulations Division
• - 2300 VIRGINIA AVENUE
NEW FORT PIERCE, FL 34982-5652
(772) 462-1553
FILLED LAND AFFIDAVIT
I, the undersigned, am the owner of the following described property,
1301-607-0234-000-9
(Parcel ld#/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.
Prop Owner ame (Please Print)
4
erty Owner Signature Date
STATE OF FLORIDA, COUNTY OF JJAZA glVef-
ACKNOWLEDGED
BEFORE ME THIS -74 DAY OF C/ / 20a -do
BY / C/G( �q/ t WHO IS PERSONALLY KNOWN TO ME (a OR WHO HAS
PRODUCED
SIGNATl7RE OF NOTARY PUBLIC
` - COMMISSION NUMBER
SLCPDSD Revised 04/11/2011
Lklpo? ce
TYPE OR PRINT NOTARY
AS IDENTIFICATION.
./
R
LAWRENCE RADA
[Niftr&[Oc, State of Florida
Commission# GG 282958
comm, expires Dec. 10, 2022
�.
:t