HomeMy WebLinkAboutFilled Land AffidavitPLANNING & DEVELOPMENT SERVICES DEPARTMENT
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,
91F<fM.1.M 111WN 1N 1.. 0..1Fl I. Ii. Eat I. RR... I. R..1 i1cIFlw.ISecANM PIFRFB,1 ReAG)IORI13N 11(6 AA]II, 1.. NTRIRMrp,FalM1m.l
(Parcel Id#/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 XQLL-0 ((LEI 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)
Property Owner Signature Date
STATE OF FLORIDA, COUNTY OF
ACKNOWLEDGED BEFORE ME THIS I IU DAY OE. �{ 20
BYEal&;, -� WHO IS PERSO YKNOWN Efly II OR WHO HAS
PRODUCED AS IDENTIFICATION.
SI NATURE OF NOTARY PUBLIC TYPE OR PRINT NOTARY
COMMISSION NUMBER
Qia+oo"" RENEE C WELLS
Notary Public • State of Florida
y' s` Commission#GG 207862
*'For a My Comm. Expires Apr 16, 2022
Bonded through National Notary AUn,
SLCPDSD Revised 04/112011