HomeMy WebLinkAboutFilled land aff PLANNING&DEVELOPMENT SERVICES DEPARTMENT
Building&Code Regulations Division
• 2300 VIRGINIA AVENUE
FORT PIERCE,FL 34982-5652
(772)462-1553
FILLED LAND AFFIDAVIT
I
I, the undersigned, am the owner of the following described property,
i
9$o G,OpmeR- Qt 04m P-D.
(Parcel Id#/Legal description/Address)
for which 1 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 comnu ttY WILL NOT be adversely
sel 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.
n rct,h �►-z�`�
Property Mner Name(Please Print)
Property q&er Signature Date
I
STATE OF FLORIDA,COUNTY OF S�• �.ww�-
i
r _ I
ACKNOWLEDGED BEFORE ME THIS 0% DAY OF D c�ol� 20
CC� ZG ,
BY 50.,, a.�.. ,,.,�,�,,a- WHO IS PERSONALLY KNOWN TO ME Zb OR WHO HAS
PRODUCED T,)-r:V4rS Ue.s...•s e_ AS IDENTIFICATION.
SIGNAT R• F NOTARY PUBLIC TYPE OR PRINT NOTARY
COMMISSION NUMBER
(SEAL)
«aY Pd•. ALEXA KRATT
® Notary Public State of Florida
P`s Commission#GG 984139
SLCPDSD Revised 04/1 I/2011 ± oF My Comm.Expires May 4,2024
Bonded through National Notary Assn.
I