HomeMy WebLinkAboutFilled Lands AffidavitST. LUCIE COUNTY _
BUILDING & Z NIN(1ECEIVED
2300 VIRGINIA AVI NUE
® FORT PIERCE, FL 349 2-5652MAR G 5 "9
o 772-462-1553
- -- - -�----_-----�� ST. Lucie County, Permitting
FILLED LANDS AFFIDAVIT
I, the undersigned, am the owner of the following described property:
3427-111-0002-000/5
(Tax 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.
Property Owner Name
Property Owner Signature Date
STATE OF FLORIDA. COUNTY OF S ; IL L [ F
ACKNOWLEDGED BEFORE ME THIS -DAY OFFM"al-I ,20-L-�
gY &CJ nW &J'a NYNIvr_WHO IS PERSONALLY KNOWN TOME OR WHO HAS PRODUCED
AS IDENTIFICATION. n
SIGNATURE NOTARY TYPE OR PRINT NAME OF NOTARY
(SEAL)
NOTARY PUBLIC TITLE
DOROTHYANN BASKIN
+; MYCOMMISSIONii GG030145
EXPIRES: October 2, 2020
8ondoa Thor Notary Public Urderxnters