HomeMy WebLinkAboutFilled Land Affidavit_ PLANNING & DEVELOPMENT SERVICES DEPARTMENT
• Building & Code Regulations Division
_ _•... m 2300 vIRGrNIA AVENUE
FORT PIERCE, FL 34982-5652
(172) 462-1553
FILLED LAND AFFIDAVIT
I, the undersigned, am the owner of the following described property,
1611-1 H.- 0 l 1 %_ - 000-1
(Parcel Id#/Legal description/Address)
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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
ge
that as owner of the above described property; and in accordance I 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.
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Propeuly Owner Name (Please Print)
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Property ignature `p I `�' a 0
Date
STATE OF FLORIDA, COUNTY OF_ ! ' k_k C I —e
ACKNOWLEDGED BEFORE ME THIS
� � � � ,� ,, DAY OF c i i/1 A I20_ '�
BY ig—G� Q M A —WHO IS PERSONALLY KNOWN TO ME )( Lr1-U
PRODUCED C OR WHO HAS
AS IDENTIFICATION.
S �NATUREOFN rAR UBLIC �IL�`Aec�. Ju�N f pN
TYPE OR PRINT NOTARY
GG.o8ygal, COMMISSION NUMBER
(SEAL )
Revised 04/11/2011
RICHARD DOUGLAS JOHNSON
N01aryPolic-SiaeoForiCahnnSLCPDSD
Comm'ssior.gGG084821
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My Comm. Expires Mar 20.2021
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