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
I, the undersigned, am the owner of the following described property,
15965 West Park Lane
(tax 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 in any form, adequate
drainage off my property which will not adversely affect the immediate community.
Bryan Harh
Property Owner Property Owner Date
(Print) (Signature)
STATE OF FLORIDA, COUNTY OF S%- L"Ci1E
SWORN TO AND) SUBSCRIBED BEFORE ME THIS r� DAY OFO cif D A3 C�. , 20 0 / ,
BY 6,C&OL �Tf` d +- WHO IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCED
AS IDENTIFICATION.
sa;- PALUS. ALKER: _ NIY CO,AR�,YJN # CO 96B034
SIGNATURE OF NOTARY TYPE OR PRINT NAME OF NOTARY o;` EXPIRES October4 200
p �,P Bonded Thru Pichard InsuranceAgnncy
NOTARY PUBLIC TITLE COMMISSION NUMBER
SLCCDV FORM NO.: 011-00