HomeMy WebLinkAboutFilled Land PLANNING & DEVELOPMENT SERVICES DEPARTMENT
M 11A 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,
006,16
(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 , 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.
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Pr%er Owner Na lease Print)
Property Owner Signature Date
STATE OF FLORIDA,COUNTY OF
ACKNOWLEDGED BEFORE ME THIS t✓ Cl DAY OF 20
BY 6► i7-LUALAY0C WHO IS PERSONALLY KNOWN TO ME ❑(�OR WHO HAS
PRODUCED 41 roll, AS IDENTIFICATION.
916GN ,LUUR OF NOTARY PUEfLIC TYPE OR PRINT NOTA R
COMMISSION NUMBER
E
iaY��''•: JENNIFER CAMPBELL
ill Notary Public-State of Florida
W` Commission/t GG 948328
My Comm.Expires Jan 16,2024
SLCPDSD Revised 04/11/2011 Bonded through National Notary Assn.