HomeMy WebLinkAboutFilled Land AffidavitPLANNING & 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,
111" 1H- UU I r - 000-
(Parcel ldt#/Legal description/Address)
jy GL 0 0 H V .Q
for which I have applied to St. Lucie County for a Final Development Permit. In
accepting this Final Development Permit, BP Number
acknowlege
that as owner of the above described property, and in accordance I with Section
7.04.0.1(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 atect the immediate
community.
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CA
Property weer Name (Please Print)
Property ignature OZ�
Date
STATE OF FLORIDA, COUNTY OF -.> k- % ,t e- 4 Q
ACKNOWLEDGED BEFORE ME THIS
14 DAY OF
B Y .{'�E•) � r... a 20—��
D WHO IS PERSONALLY KNOWN TO ME OR WHO HASPRODUCED
AS IDENTIFICATION
S NATURE OF N r UBLIC1L�AP
TYPE OR PRINT NOTARY
GGog�ea� COMMISSION NUMBER
(SEAL)
RICHARD DOUGLAS JOHNSON
• : n\�•� • Notary Public - Siale of Florida
SLCPDSDRevised04/11/2011 [Commissnor#GG084821
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