HomeMy WebLinkAboutFilled Land AffidavitST. LUCIE COUNTY PUBLIC WORKS
BUILDING & ZONING DEPARTMENT
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
561-462-1553
FILLED LANDS AFFIDAVIT
i471- 50t, 003Z"V00/ 147A-56f.4o33.ow/iv itq',�rDI.OD3S'Owfz,
1, the undersigned, am t e owner of the following described property, N� Co�-ef
(tax ID/legal description/address)
for which I have applied to St. Lucie County for a Fina)D veto rr�ent Permit. In accepting
this Final Development Permit, BP Number () CJ I acknowledge that as
owner of the above described property, and in accordance ith 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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Property dwner Property Owner Date
(Print) (Signature)
STATE OF FLORIDA, COUNTY OF Sr-
SWORN TO AND SUBSCRIBED BEFORE ME THIS ✓ DAY OF �,0nt1A QY , 2001,
BY AARII/A/ &A.S TAdFi-' WHO IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCED
AS IDENTIFICATION.
A. Priout
G TURE OF NOTARY TYPE OR PRINT NAME OF NOTARY S``{ Co aai0U0CC971587
3vi 4 Fxpires Nov. 7, 2004
Bonded Thm
NOTARY PUBLIC TITLE (525 f7150 7 COMMISSION NUMBER uii Auc •Bonding Co., Inc
SLCCDV FORM NO.: 011-00