HomeMy WebLinkAboutFilled land aff_ �Me 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,
3414-501-0715-200-5 / ST LUCIE GARDENS 23 36 40 BLK 3 E 400 FT OF N 111
(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.
f� T ►e�i��� C -
Property caner Name (Please Print) //
roperty 4 er Signature Date
STATE OF FLORIDA, COUNTY OF �)Cn,`
ACKNOWLEDGED BEFORE ME THIS Z l DAY OF {�1,1 (,i 120 2 0 ,
BY UAC- JY �iY� IVAI WHO IS PERSONALLY KNOWN TO ME OR WHO HAS
PRODUCED
SIGRATT1RE OF NOTARY PUBLIC
Go '1COMMISSION NUMBER
SLCPDSD Revised 04/11/2011
AS IDENTIFICATION.
c, )c\ \� �, `fie e Se.
TYPE OR PRINT NOTARY
PRISCILLAREES]4884
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Notary Public -State of
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Commission a GG 13
My Comm. Expires Dec