HomeMy WebLinkAboutFilled Land Affidavit I
;------- - --, 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,
3529-231-0006-000-5/ 10009 S Indian River Dr, Fort Pierce FL 34982
(Parcel IM/Legal description/Address)
for which I have applied to St. Lucie County for a Final Develo ent Permit. In
accepting this Final Development Permit, BP Number 7 oo 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.
Pro erty caner Name lease Print) —
Property Owner Sign tune Date
STATE OF FLORIDA,COUNTY OF
ACKNOWLEDGED,BEFORE ME THIS DAY OF 20,1_Q
BY WHO IS PERSONALLY KNOWN TO ME a OR WHO HAS
PRODUCED ,-! AS IDENTIFICATION.
I
SIGNATURE OF NOTARY LIC TYPE OR PRINT NOTARY
CJ�MMISSION NUMBER
(SEAL)
�N r�
SLCPDSD Revised 04/11/2011
Cow f Flo
ri V'q(/
My Co'ssionaa Kota ly/V
0\��9tssio�(;2�oQUbhc
\ E7 �02pirgs 9
2
i
i