HomeMy WebLinkAboutFilled Land Affidavit Cz, rr
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PLANNING &DEVELOPMENT SERVICES DEPARTMENT
Building&Code Regulations Division
2300 VIRGRQA AVENUE
FORT PIERCE,FL 34982-5652
(772)462-1553
FILLED LAND AFFIDAVIT
I
I,the undersigned,am the owner of the following described property,
(Parcel IM/Legal descripti 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 WELL 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)
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Property Owner Signature IAte
STATE OF FLORIDA,COUNTY OF Z ��
ACKNOWLEDGED BEFORE ME TIES/�_DAY OF (/� _20 L /-
BY t I V" WHO IS P ALLY KNOWN TO ME(_)OR WHO HAS
PRODUCED unl AS IDENTIFICATION.
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SIGNATURE OF rfARY PUBLIC YPE OR PRINT NOT Y
COMMISSION NUMBER
(SEAL)
SLCPDSD Revised 04/11/2011 ;o �Pqp AUDREY B.HUMPHREY
MY COMMISSION#FF 174772
EXPIRES:March 6,2011
oe` BondedThmNotaryPubl'cUndenrrtters
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