HomeMy WebLinkAboutFilled Land AffidavitPLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772)462-1553 -
FILLED LAND AFFIDAVIT AGG 2 ® �20
ST. Lucie County, Permitting
I, the undersigned, am the owner of the following described property,
325 nettles blvd jensen beach fl 34957
(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.
P erty Owner Name (P int)
Property Owner Signature Date
STATE OF FLORIDA, COUNTY OF v] "
ACKNOWLEDGED BEFORE ME THIS DAY OF _ 20-C�0
QS
WHO IS PERSONALLY KNOWN TOME Q OR WHO HAS
PRODUCED
SIGNATURE OF NOTARY PUBLIC
COMMISSION NUMBER
SLCPDSD Revised 04111/2011
AS IDENTIFICATION.
TYPE OR PRINT NOTARY
��I_
STELLA M HUNTER
Notary Public - State of Florida
# G
My CommComm�ssion n81062
Expires
Bonded through National Notary Asssn.