HomeMy WebLinkAboutFilled Land Affidavitn•i
t
ST. LUCIE COUNTY
BUILDING & ZONING
2300 VIRGINIA AVENUE
FORT PIERCE, FL.34982-5652
772-462-1553
FILLED LANDS AFFIDAVIT
I, the undersigned, am the ownerof the followingJ'described property:
(E6Z L�.k ... •• 3—A,,- J - I •CL 34 i0�^Cz_
(Tax 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 WELL L 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.
Property Owner Name Vopertyy Owner Signature Date
STATE OF FLORIDA, COUNTY O
ACHINDWLEDGED BEFORE" -AY OFBY et�(o y �% LL+ G% WHO IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCED
cJ/j- [' • ` AS IDENTIFICATION.
ce-2.64, =>.
SIGNATURE OF ARY TYPE OR PRINT NAME O NOTARY
(SEAL)
NOTARY PUBLIC TITLE COMMISSION NUMBER
•pY PU •' AUDREY B. HUMPHREY
MY COMMISSION G2 23
G1
-+ E(pIRES' March 63 ;tess
Q. ota PublicUndetwr_
.,9TFOF FV�`• Bonded Ttl(U