HomeMy WebLinkAbout005 Filled Land Affidavit..f= e � n. .. <
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772)462-1553
FILLED LAND AFFIDAVIT
I, the undersigned, am the owner of the following described property,
1418-133-0040-000-7 / 4700 Indrio Rd. Ft Pierce 34951
(Parcel 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.
Ross Chambers
P7rope >Jagle (P ase Print)
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Property Owner Signature Date
STATE OF FLORIDA, COUNTY OF S k • CA4.c_L-P
ACKNOWLEDGED BEFORE ME THIS 2� DAY OF k 20 Zo
BY &5 ("'-5 WHO IS PERSONALLY I OWN TO ME ( ) OR WHO HAS
SIIGJNATUIRE� OF NOTARY PUBLIC
�S q' "1 O COMMISSION NUMBER
SLCPDSD Revised 04111/2011
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TYPE OR PRINT NOTARY
AS IDENTIFICATION.
PU* Notary Public State of Flonda
Nikki Cutler
p< My Commission GG 189140
oc ao� Expires 02122/2022