HomeMy WebLinkAboutFilled Lands Affidavit- I PLANNING & DEVELOP
MENT SERVICE DEPARTME
Building & Code Regulations NT
.Divi ion
2300 VMGINJA AVENUE
FORT PIERCE, FL 34982 5652
(772) 462-1553
FILLED LAND AFFWAVIT
I, the undersigned, am the owner of the following describe
4426-815-OU42-000-6 B�ITTOIVBUSH VILLAGE F�ARBOUR RfDGE-PLAT 73 UNIT 35 y d p peI�y,
1•� at'e-'1 lyd#%L�PI�descr'7�iOB�.4� w 3336 NW MAPLEINDQD RD P&IRS City, ty FL 34930
for which I have appli
accepted to St. Lucie County for a Final
ing this Final Development Permit, BP Number
that as owner of the above described praperty� and in
7.04.01(D), St. Lucie County Land Develop
adequate drainage so that the immediate convent Code, I shah
I further acknowledge that in mmunity WIL r
St. Lucie County is neither obliged nor liais bler oltpr T tde` de -v
adequate drainage off Iny pro ert for;
community. p Y which will not advert
t�
Pra e �
P nY owner Name (Please Print)
W e weer Signature
STATE OF FLORIDA, COUNTY OF
ACKNOWLEDGED BEFORE ME THIS
bAY OF
BY
PR0)I]UCE17 WHO IS PERSONALLY KNOWN TO 2,,M
S N T F NOTARY PUBLIC
TYPE ORP NOTARY
COMi+,gSSION NUMBER
(SEAL)
SLCPDSD Revised 04/11/2011
Permit. In
acknowledge
cordance with Section
responsible for assuring
C be adversely affected,
pment of this property,
maintain in any form,
affect the immediate
— 20,Z-4jD _
I
OR WHO HAS
IDENTIFICATION.