HomeMy WebLinkAboutFilled Land AffidavitI-- 5
ST. LUCIE COUNTY
BUILDING & ZONING
•[
2300 VIRGINIA AVENUE
FORT PIERCE. FL 34982.5652
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Se1-462•1553
FILLED LANDS AFFIDAVIT
r of the following described property:
I, the undersigned, am the owne
J-r - —
(rax ID1Legal descriptloNAd ress
for which I have applied to St. Lucie County for a Final Development
Permit.
I ackn wledge that accepting a
this Final Development Permit, BP Number
owner of the above described property, and in accordance with Sectionssur�g adequate
Lucie County Land Development Code, shall
WILL NOT beresponsible
ersely affected. I further
drainage so that the immediate comet y
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 to c mmuniany form, adequate
drainage off my property which will not adversely affect t
he
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Property Owner Name
gnature Date
Property Owner Si
r� r uCi�
STATE OF FLORIDA. COUNTY OF �
ACKNOWLEDGED BEFORE ME THIS
DAY OF 7U N . 2012.
�jnoNn�IG�
WHO IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCED
By
I/mow @d't L (C N S E AS IDENTIFICATION.
SIGNATURE OF NOTARY TYPE OR PRINT NAME OF NOTARY
(SEAL)
Q107ej( 9 � COMMISSION N @ti ,gam DONALD M. HOLMAN
NOTARY E IaI Ic TITLE =_ Commission DD 704898
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