HomeMy WebLinkAboutFilled land affPLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division
2300 VIRGINIAAVENUE
FORT PIERCE, FL 34982-5652
(772) 462-1553
FILLED LAND AFFIDAVIT
I, the undersigned, am the owner of the following descri ed property,
(Parcel IM/Legal description/Address)
for which I have applied to St. Lucie County for a Final De o ment Permit. In
accepting" this Final Development Permit, BP Number p - 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.
P o-perty Owner Name (Please Print)
Pro erty Owner Signature/ Date
STATE OF FLORIDA, COUNTY OF Luce
ACKNOWLEDGED BEFORE ME THIS d- ( DAY OFF 120
BY Pa AA I '<CAA`�Pf!2)_WHO IS PERSONALLY KNOWN TOME L—) OR WHO HAS
PRODUCED AS IDENTIFICATION.
SIGNATURE OF NOTARY RJBM TYPE OR PRINT NOTARY
�7M OMMISSIONNUMBER
I X�.—
SLCPDSD Revised 04/11/2011
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