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PLANNING & DEVELOPMENT SERVICE&DEPARTMENT
Building* Code Regulatio
ns Division ivision
2300 VIRGLNLIA AVENUE
FORT PIERCE, FL 34982-5(;52
(772) 462-1553
FILLED LAND AFFIDAVIT
1, the unddrsigned, am the owner of the following, described property,,
(Parcel
for which I have applied to St. Lucie, County for a Final Development Permit. In
awepting this Final Development Permit, BP Number I acknowledge
that, as owner of the above described property, and - 'in accordance with.I Section
7.04.01(l)), St. Lucie County Land Development Code, 1-shall, be responsible for assuring
adequate -drainage so that the immediate cor=unity RILL NOT be adversely, affected.
I further acknowledge that in granting this permit for the development * :ofthis 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-
PDAMI, HAAkOS
'Froperty Oivner Name eas Trl 0
Proper tyOl5wner-:SIFM�V" Dam
STATE OF FLORIDA, COUNTY 0i21 LAA
ACKNOWLEDGED BEFORE ME THIS DAY OF
20 70
BY M ILEALRAWK19S 0 IS PERSONALLY KNOWN TOME QSiR WHO HAS
PRODUCED AS IDENTIFICATION.
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LT MOFNO AT# UB6 TYPE OR PRTNT'NOTARY1
qu.9-1:6 COMMISSION NUMBER .
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SLCPDSD Revised 0411. V2011
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