HomeMy WebLinkAboutFilled Lands AffidavitST. LUCIE COUNTY PUBLIC WORKS
BUILDING & ZONING DEPARTMENT
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
561462-1553
FILLED LANDS AFFIDAVIT
I, the undersigned, am the owner of the following described property,
(tax 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.
x Ind• N . 7,—,-
Property Owner Property Owner Date
(Print) (Signature)
STATE OF FLORIDA, COUNTY OF
SWORN TO AND SUBS'CLRIBEEDD BEFORE ME THIS AY OF � , 20
BY /� /�Il�-,� /T la Al 0 IS PERSONALLY KNO N TO ME OR 40 HAS PRODUCED
02- IDENTIFICATION.
(seal)
*IGNATURE OF NOTARY TYPIE OR PRINT NAME OF NOTARY
4''L�►�y* Kathleen CHO
NOTARY PUBLIC �* My commission CC959482 COMMISSION NUMBER
Expires August 8, 2004
SLCCDV FORM NO.: 011-00