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PLANNING &DEVELOPMENT SERVICES DEPARTMENT
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,
1 30l - 19o1 - 06`7co-DOD- ' -71901 Are
(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 j
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.
Iry.T L LC-.,
Propert wn r Name(Please Print)
to
Property Owne Signature Date
STATE OF FLORIDA,COUNTY OF ;/'� i
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ACKiN'OWLEtDGED BEFORE ME THIS DAY OF C� 20
BY C 1 \aDy t WHO I cn�al r Y Kh_ O ME(❑)OR WHO HAS
PRODUCED AS IDENTIFICATION.
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SIGNATURE OF NOTARY PUBLIC TYPE OR PRINT NOTARY
aaJ- 1.01 I
V (�L O COMMISSION NUMBER
(SEAL)
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SLCPDSD Revised 04/11/201I ccnW MH D� �p
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