HomeMy WebLinkAboutFilled Land Affidavit1
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,
(Parcel Id#/Legal
for which I have applied to St. Lucie County for a Final Development Permit. In
accepting this Final Development Permit, BP Number 1912' t70rf(o, 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.
Kevin Borkenhagen
Property Owner Name (Please Print)
Property O er Sign
STATE OF FLORIDA, COUNTY OF�I'Iii'IiM eef la'
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ACKNOWLEDGED BEFORE ME TIES 4_ DAY OF h 20�
BY Kevin Borkenhagen WHO IS PERSONALLY KNOWN TOME OR WHO HAS
PRODUCED
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SIGNALMOF NOTARY POBLIC
PrA gt?jj*COMMISSION NUMBER
SLCPDSD Revised 04/11/201I
AS IDENTIFICATION.
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TYPE OR PRINT NOTARY
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Bonded throu5h National Notary Assn.
SPECIAL NOTICE
(PLEASE READ BEFORE SIGNING ACKNOWLEDGMENTS BELOW)
Submission of this application does not constitute the granting of approval. All appropriate requirements must
be met prior to this project being presented for approval to the appropriate authority. St. Lucie County reserves
the right to request additional information to ensure a complete review of this project.
ACKNOWLEDGMENTS
Applicant Information (Property Developer): Agent Information:
Business Name: K. Hovnanian Homes Business Name:
Name: Kevin Borkenhagen Name:
Address: 3601 Quantam Blvd. Address:
Boynton Beach- FL. 33426
(Please use an address that can accept overnight (Please use an address that can accept overnight
packages) packages)
Phone: 561-364-3309 Phone:
Fax: Fax:
Email: kborkenhagen(cDkhov,com Email:
Please note: both applicant and agent will receive all official correspondence on this project.
Property Owner Information
This application and any application supplement will not be considered complete without. the notarized
signature of all property owners of record, which shall serve as an_ acknowledgment of the submittal of this
application for approval. The property owner's signature below shall also serve as authorization for the above
applicant or agent to act on behalf of said property owner.
Propatly SlgnaWre Property Owner Name (Printed)
Mailing Address: 01 Quantam Blvd, Phone: 561-364-3309
If more than one owner, please submit additional
Boynton Beach, FL. 33426 pages E STATE OF FI A , COUNTY OF Q�I CYO 9 C
The foregoing Instrument was acknowledged before me this .. LtM day of ' 11 U_; 20 IQI
by (( DNAt(1 gCN Cs211 in_� who is personally -known to me, or who has produced
y as identification.
Signature of Notary - Type or, Print Name of Notary
CaCa,(�63: CommissionNumber.(Seal)
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Page 5 of 8 071 NotaryPubllc-StataofNaida
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