HomeMy WebLinkAboutFilled Land AffidavitPLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division
2300 VIRGRZA AVENUE
FORT PIERCE, FL 34982-5652
(772) 462-1553
FILLED LAND AFFIDAVIT
I, the undersigned, am the owner of the following described property,
01-(:)[ F64 ®c)o/5 3i3 AJnAg3 Sot
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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 (Please Print)
Properly OwnerQi�natu�re��
STATE OF FLORIDA, COUNTY OFPi�2 i
Date
ACKNOWLEDGED BEFORE ME THIS DAY OF � . 20-
BY L� @A#V— _ 1 � ��l A&t,,, _ WHO IS PERSONALLY KNOWN TO ME (M OR WHO HAS
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%yh I1�sa L,....
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COMMISSION NUMBER
AS IDENTIFICATION.
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TYPE OR PRINT NO&kRY
(SEAL)
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MY COMMISSION # GG 275060
SLC PDSD Revised 04/11/2011 7.022
" EXPIRES: December 20,
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Bonded lbru Notary
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