HomeMy WebLinkAboutFilled Land AffidavitPLANNING & DEVELOPMENT SERVICES DEPARTMENT
• Building & Code Regulations Division
2300 VIRGIMA AVENUE
FORT PIERCE, FL 34982-5652
(772) 462.1553
FILLED LAND AFFIDAVIT
I, the undersigned, am the owner of the following described property,
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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.
PMS
Property Owner Name (Please Print) //�� a aa f1
\.,Perry v Igtature 1 IaP
Date
STATE OF FLORIDA, COUNTY OF S t I Id C 14
ACKNOWLEDGED BEFORE ME THIS 9 DAY OF two r e h 20 1 v
BY R YV q tares 4,.K s WHO IS PERSONALLY KNOWN TO ME L , OR WHO HAS
PRODUCED
AS IDENTIFICATION.
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TYPE OR PRINT NOTARY
GGD$4R.71 COMMISSION NUMBER
(SEAL)
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SLCPDSD Revised 04111/20
RICHARD DOUGLAS JOHNSON
Wary Public - Stale of Banda
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