HomeMy WebLinkAboutFlack Filled Land Aff71 j PLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division
2304 VIRGINIA AVENUE
FORT PIERCE, FL 34482-5652
(772)462-1553
FILLED LAND AFFIDAVIT
I, the undersigned, am the owner of the following described property,
1%600 /\ARCH orae TR — POrt 5t We e „ FL 3q q'97
(Parcel Id#Illegal 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.
LSI-6alt
Property Owner Name (Please Print)
�Property Owner Signature
STATE OF FLORIDA, COUNTY OF M A 8101
7
Date
ACKNOWLEDGED BEFORE ME THIS �� DAY OF '20
BY tA S A FLACK WHO IS PERSONALL KNOWN TO ME (_) OR WHO HAS
PRODUCED F L49,0 -5 0.a, —0- 47 A-0 F L D P, V c As IDENTIFICATION.
SIGN RE OF NOTARY PUBLIC TYPE OR PRINT NOTARY
96,a$(�1q0 COMMISSION NUMBER
(SEAL)
REK
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G 290149
SLCPDSD Revised 04/1112011 22