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:1 PLANNING &DEVELOPMENT SERVICES DEPARTMENT
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® " Building&Code Regulations Division Raeel
- 2300 VIRGINIA AVENUE
FORT PIERCE,FL 34982-5652
(772)462-1553 Per�ltti ue a ceu ren+
FILLED LAND AFFIDAVIT
I.the undersigned, am the owner of the following described property,
3 S' T ra�O�cA I Ts i<s C;v-c l^e. - F-b y fi P;.e"'CA
(Parcel Id#/Legal description/Address)
y for which I have applied to St. Lucie County for a Final Development Permit. In
accepting this Final Development Permit, BP Number zoo 3- 0)13, 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.
Property Owner Na (PIKase Prin)
Prop wner Signature Date
STATE OF FLORIDA,COUNTY OF
ACKNOWLEDGED BEFORE ME THIS _DAY OF nor—1.4 ;20 0
W SONALLY KNOW 0 ME OR WHO HAS
PRODUCED AS IDENTIFICATION.
SIGNATURE OF NOTARY PUBLIC I UK FIGN-1
Notary Public State of Florida
COMMISSION NUMBER :4 Rick Meadows
MY Commission GG 952822
aw Expires 01/28120 AL)
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SLCPDSD Revised 04/11/2011