HomeMy WebLinkAboutFilled Land Affidavit PLANNING& DEVELOPMENT SERVICES DEPARTMENT
• Building&Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE,FL 34982-5652
(772)462-1553
FILLED LAND AFFIDAVIT
1,the undersigned, am the owner of the following described property,
fr4w-et VL�q-k lot,-Vp ,
(Parcel ld#/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.
% 6 in
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Property Owner Name(Please Pr int)
Property Owner Signature DatV
STATE OF FLORIDA,COUNTY OF A r 0 W 0 4%
ACKNOWLEDGED BEFORE ME THIS 0 DAY OF 20
BY. X- WHO IS PERSONALL OWN�TO ME
j OR WHO HAS
PRODUCED
AS IDENTIFICATION.
SIGNATURE OF NVjARY PUBLIC TYPE OR PRINT NOTARY —
COMMISSION NUMBER
(SEAL)
SLCPDSD Revised 04/11/2011
- - - - ------ --
AUDREYS.HUMPHREY
MY COMMISSION#GG 300817
EXPIRES:March 6,202?
Bonded Thru Notary Public Urer