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PLANNING& DEVELOPMENT SERVICES DEPARTMENT
o Building &Code Regulations Division
• - 2300 VIRGINIA AVENUE RECEIVED
FORT PIERCE,FL 34982-5652
(772)462-1553
JAN 17 2017
FILLED LAND AFFIDAVIT PER!'01TTING
St. Lucie County, FL
I,the undersigned, am the owner of the following described property,
793 Shp,(-) D12-2- R r_ 0L-) R- -F - Psi 9 �z
(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.
Property Owner Name(Ple Print)
Property Owner Sigcla a Date
STATE OF FLORIDA,COUNTY OF �(/C•C
ACKNOWL GED BEFO ME THIS • DAY OF 120
BY WHO IS PERSONALLY KNOWN TO ME OR WHO HAS
PRODUC c �— AS IDENTIFICATION. ,
SIGN UURRE OF NOTARY PUBLIC TYPE OR PRINT NOTARY
COMMISSION NUMBER
(SEAL)
ROBERiT El
MY COMMISSION#FF 95=
- EXPIRES:January 12,2020
;F fig. Bonded Thru Notary Public Underwriters
SLCPDSD Revised 04/I 1/2011
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