HomeMy WebLinkAboutFilled Land AffidavitST. LUCIE COUNTY PUBLIC WORKS
BUILDING & ZONING DEPARTMENT
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
561-462-1553
FILLED LANDS AFFIDAVIT
I, the undersigned, am the owner of the following described property,
(tax ID/legal description/address)
for which I have applied to St. Lucie County for a Final Development Permit. In accepting
this Final Development Permit, BP Number,21n ? 05a9 1.1 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.
A //1 ,e ` /&? :�2%i 27_ � --21-PZ12mo/
Property Owner Property Owner Date
(Print) (Signature)
STATE OF FLORIDA, COUNTY OF MaX TI jQ
SWORN TO AND SUBSCRIBED BEFORE ME THIS a� DAY OF , 204aZ
BY &keA//i /fi • �le� WHO IS PERSONALLY KNOWN TO AE O WHO HAS PRODUCED
AS IDENTIFICATION.
(seal)
GNATUR. F N ARY TYPE OR PRINT NAME OF NOTARY O}gIN �tYSEAL
IAUIRIE A KUNZMAN
NOTARY PUBLIC TITLE COMMISSION NUMBER �Y�UCSTATEOFFLORIDA
CoMMMON NO. CC650660
COMMLiON EXP. 7 1
SLCCDV FORM NO.: 011-00