HomeMy WebLinkAboutFilled Land AffidavitPLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772)462-1553
FILLED LANDS AFFIDAVIT
I, the undersigned, am the owner of the following described property,
P/ATIVo 9-r ,
(Parcel Id#/Legal
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 fur -the -development of this property;- y -
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.
A C-_ t
Property Owner Name (Please Print)
C�
Pro erty Owner Signature Date
STATE OF FLORIDA, COUNTY OF 5* , L V C %-k
ACKNOWLEDGED BEFORE MET IS 1 � }� DAY OF J \ y , 20 1
{�
BY kk W% V, R.3 •%AkyJ WHO IS PERSONALLY KNOWN TO ME OR WHO HAS
PRODUCED V"n 01*0 — \1 I — 31 NeO 5 ' 10 AS IDENTIFICATION.
SIGNATURE OF NOT Y PUBLIC
.t4%+141�MMISSION NUMBER
DEANNA GIVENS
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Notary Public -State of Florida
My Corn(��p ��{?�ires Dee 16, 2016
CornrnIssio # EE 858761
; Bonded Through National Notary Assn.
SLCPDSD Revised 08/24/2010