HomeMy WebLinkAboutFilled Land AffidavitCW-M
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,
I,�II- luu- pinq- 110-I R3o� CY�,c I-�t c
(Parcel IdMILegal descnptlon/Address)
for which I have applied to St. Lucie County for a Final Development Permit. In
accepting this Final Development Permit, BP Number
ac
that as owner of the above described property, and in accordance I with Sectdion
7.04.01(D), St_ Lucie County Land Development Code, I shall be responsible for assuring
adequate drainage so that the immediate community WII_� 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 an for
adequate drainage off my property which will not adversely affect the y m,
community. immediate
Property Owner Name (Please Print)
Property gnatr,
Date
STATE OF FLORIDA, COUNTY OF_ I U
ACKNOWLEDGED BEFORE ME THIS
BY
DAY OF _rn 20
PRODUCED rn (` _ J
J WHO IS PERSONALLY KNOWN TOME A) OR WHO HAS
\AS 1IDENTIFICATION.
4NATUREOFN
rAR UBLIC �IL�AF� Q1A I Vt�"1NdOH
TYPE OR PRINT NOTARY\CrCros—
4 COMMISSION NUMBER
(SEAL)
SLCPDSDRevised04/II/2011COmm;sslon9GG084821
mt
RICHARD DOUGLAS JOHNSON
Notary Public - Stale of FloriCa
1
'7*..'
Fv. ?',..
• My Comm. Expires Mar 20. 2021
i
Bonded Ihrouyh Nalmnal NalaryAssn.