HomeMy WebLinkAboutFilled Land Affidavit�JL�E COGy ST. LUCIE COUNTY
BUILDING & ZONING.
2300 VIRGINIA AVENUE
't FORT PIERCE, FL 34982-5652
F�0R10A 561462-1553
FILLED LANDS AFFIDAVIT
.l, the undersigned, am the owner of the following described property:
CV7-(31% )qb -�64-41 MCC V9 9 7
(Tax ID/Legal descrlpbon/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.
Property Owner Name
STATE OF FLORIDA, COUNTY OF IZa LU `119
Property Owner Signature Date
ACKNOWLEDGED BEFORE ME THIS 'W DAY OF . 20
BY?V�)949' ln: `BW 6") k! WHO.IS PERSONALLY KNOWN TO ME OR WHO
�HAS
, PRODUCED
r /.A' 2)'-' /-,C, AS IDENTIFICATION. IOJ�' J' �` 7. 4Q57) - v
W, ow, , mz, I r! W, OEM
V
TYPE OR PRINT NAME OF NOTARY
(SEAL)
NOTARY PUBLIC TITLE COMMISSION NUMBER
AUDREV B. H1""
AV CpMMISSION HR
Bonded PRE . March g �00 03-
H°try Public UnderMiters