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PLANNING & DEVELOPMENT SERVICES DEPARTMENT
• Building & Code Regulations Division
2300 VIRGINLA AVENUE
FORT PIERCE, FL 34982-5652
(772) 462-1553
FILLED LAND AFFIDAVIT
I, the undersigned, am the owner of the following described property,
Ilia I311-100- 013LI IDO S
(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
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 N T 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.
?) Ir NQ Y\ iqOla hnS
Property Owner Name (Please Print)
Pro er I V
P h ignature Date
STATE OF FLORIDA, COUNTY OF V � I Vt ( I 1
ACKNOWLEDGED BEFORE ME THIS •t h DAY OF h
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BY bYyq yN VqaG yes WHO IS PERSONALLY KNOWN TO ME
PRODUCED (x ) OR WHO FIAS
AS 'IDENTIFICATION
S NATURE OF N rAR UBLIC
TYPE OR PRINT NOTARY
&&DRIBal COMMISSION NUMBER
(SEAL)
• «µ�'o;;' •.
A
RICHAP,D DOUGLAS JOHNSON
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SLCPDSDRevised 04/II/2011 Itm\1
Notary Public - Stale o(Flnrida
Commissior.AGG08482.1
V.
Y P M Comm. Expires Mar 20.2021
Bunded ihrooyh National Notary Assn.