HomeMy WebLinkAboutFilled Lands AffidavitPLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division
2300 VIELOD IA AVENUE
FORT PUMCE, FL 34982-5552
(772) 462-1553
PILLED LAND AFTIDAVIT
L the undersigned, am the owner ofthe following described property,
O arcel ld#ILgd description/Address)
rL �y9ys
for which I have applied to St. Lucie County for a Firlai Pevelopment 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 Cade, 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,
SL Lueie County is neither obliged nor liable to provide for, or maintain in dray form,
adequate drainage off my property which will not adversely affect the immediate
community._
kfOjgRjd �SAC-�E
Property Owner a ne lease Print) j
J
Pr ' Owner signage Date
STATE OF FLORIDA, COUNTY OF -5 >
ACKNOWLEDGED BEFORE ME THIa2zDAY OF � � 20 ,
BYO IS PERSONALLY KNOW TO ME OR WHO HAS
SIGNATURE OF NOTARY PUBLIC
GGCOhMSSION NUM13ER
SLCPDSD Revised 0411 I12011
AS IDENTIFICATION.
TYPE OR PRINT NOTARY
(SEAL)
SHARON MILLER
s O�O,FY P(,B i
State of Florida-NotarY Public
*= Commission # GG 202177
My Commission Expires
Aprlt 01, 2022