HomeMy WebLinkAboutFilled Land AffidavitPLANNING &'DEVELOPMENT SERVICES DEPARTMENT
•-11
Building & Code Regulations Division
IM.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,
lall luu Ulu- 000-1
(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
acknowlege
that as owner of the above described property, and in accordance I 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.
Gn �da"IS
Property Owner Name (t)
Property i gnature
Date
STATE OF FLORIDA, COUNTY OF v� 114 C 14
ACKNOWLEDGED BEFORE ME THIS _u
8 Y� DAY OF
BY �d a 1 1 S WHO IS PERSONALLY KNOWN TO ME
PRODUCED (x , OR WHO HAS
AS IDENTIFICATION
S NATURE OF N rAR UBLIC IL�AQ� Q1� JV�N30H
TYPE OR PRINT NOTARY
GGogyga� COMMISSION NUMBER
(SEAL)
SLCPDSD Revised 04/1112011 ;� a �'f
RICHAP,D DOUGLAS JOHNSON
Nolary Public - Slate of Florida
Comm;ssior.pGG084821
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My Comm. Expires Mar 20. 2021
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