HomeMy WebLinkAboutFilled Land AffidavitPLANNING & DEVELOPMENT SERVICES DEPARTMENT
NAM Building & Code Regulations Division.
2300 VIRGINIA AVENUE
�r FORT PIERCE, FL34982-5652
(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 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 fo'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.
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PropertyOwner Name (Please Print)
2erty Ignature Date
STATE OF FLORIDA, COUNTY OF_S 1 I u C 1 A
ACKNOWLEDGED BEFORE ME THIS _ I ( DAY OF FX b 20 a Q
BY &.rn Q cLcxyYl. S WHO IS PERSONALLY KNOWN TO MEC , OR WHO HAS
PRODUCED
SIGNATURE OF M ARY HLIC
GG0848al COMMISSION NUMBER
SLCPDSD Revised 04/11/2011
IDENTIFICATION.
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TYPE OR PRINT NOTAIW
(SEAL)
,.+•p,:';';,; RICHARD D00GLAS JOHNSON
;� Nolary PuhOc-Stale of Florida
Commission k GG 084821
My Comm. Expires Mar 20,2021
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