HomeMy WebLinkAboutFilled Land Affidavit R, PLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building&Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE,FL 34982-5652
(772)462-1553 RECEIVED
FILLED LAND AFFIDAVIT Of T 0-7 2U1U
Permitting Department
St.Lucie County
I,the undersigned, am the owner of the following described property,
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(Parcel I #/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 in any form,
adequate drainage off my property which will not adversely affect the immediate
community.
Property Owner Name(Please Print)
ok CP-
Property Owner Signature Date
STATE OF FLORIDA,COUNTY OF /
ACKNOWLEDGED BEFORE ME THIS 1 DAY OF 207
BYE�P.\ ( � iV�. enR WHO IS PERSONALLY KNOWN TO ME 12 OR WHO HAS
PRODUCED AS IDENTIFICATION.
SIGNA E OF AR L TYPE OR PRINT NOTARY
COMMISSION NUMBER
oiPHY pV, KAREN S. NIELSEN
State of Florida-Notary Public j
_• Commission # GG 207484
'j� F F1.OP� My Commission Expires
SLCPDSD Revised 04/11/2011 F'O June 12, 2022