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PLANNING & DEVELOPMENT SERVICES DEPARTMENT
• Building & Go
Regulations Division.
' 2300 VIRGIIVIA AVENUE
FORT PIERCE, FL 34982-5652 �ECEL�h
(772) 462.4553
FILLED LAND AFFIDAVIT Department
per St tLu ie county .
I, the undersigned, am the owner ofthe following described property,
5a16 BiY( h Dr u Da - LpoZ-- Doo-)
(Parcel 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 . 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' ii.i any form,
adequate drainage off my property which will not adversely affect the immediate
community.
Property weer Name (Please Print)
a�a�lao
Property ignature Date
STATE OF FLORIDA, COUNTY OF
ACKNOWLEDGED BEFORE ME THIS 28 DAY OF Fa Y,., 20 2-o
BY .$ r q rJ hO q mS WHO IS PERSONALLY KNOWN TO ME c x , OR WHO HAS
PRODUCED AS IDENTIFICATION.
V�+r J
S IOONIA.3 Q�MSON
NATURE OF N AR LIC TYPE OR PRINT ]NOTARPT
6frQ84%&j COMMISSION NUMBER
(SEAL
,,. �siC'P„ • RICHARD DOUGLAS JOHNSON
_ io
Notary Public- Slate of FloridaCommission # GG 084821SLCPDSDRevised 04/11/2011 - ;�o`S My Comm. Expires Mar20.2021
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