HomeMy WebLinkAboutFilled land affPLANNING & DEVELOPMENT SERVICES DEPARTMENT
s , t J " Building & Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772)462-1553
FILLED LAND AFFIDAVIT
I, the undersigned, am the owner of the following described property,
2308-314-0003-000-6 497 S. Brocksmith Road Ft Pierce 34945
(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 in any form,
adequate drainage off my property which will not adversely affect the immediate
community.
Jared Modine
PropertZOjNarne (Please Print)
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VjU ,7 Zo2o
ProperUwner Sl ature Date
STATE OF FLORIDA, COUNTY OF
ACKNOWLEDGED BEFORE ME THIS act DAY OF ( ( l�/1 �j , 20r-) ( '\,
BY J (�J�Jt' Lt(Jt &'--WHO IS PERSONALLY KNOWN TO ME (Iv _�) OR WHO HAS
SIGNATURE OF NOTARY PUBLIC
IG
\� 1 `�O COMMISSION NUMBER
SLCPDSD Revised 04/11/2011
AS IDENTIFICATION.
TYPE OR PRINT NOTARY
(SEAL)
=*� State of Floridaon GG 189140/2022