HomeMy WebLinkAboutFilled Lands AffidavitST. LUCIE COUNTY PUBLIC WORKS
BUILDING & ZONING DEPARTMENT
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
561-482-1553
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 Fi ail v��lo,�nent Permit. In accepting
this Final Development Permit, BP Number Gl I �•1U 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.
Property Owner �(Si
ty Owner Date
(Print) rd,6 '$flSef'lr {� 1�Rve gnatur
STATE OF FLORIDA, COUNTY OF
SWORN TO AND SUBSCRIBED BEFORE ME THIS , 20 D ,
BY 0 () 2 7-1A /10'Et/ %71 WHO IS SONALLY NOWN TOM R WHO HAS PRODUCED
� r Tracy Ann Hysell
`
'AS IDENTIFICATION. 0 *My Commission CC748683
Expires June 7, 2002
S (seal)
TURE NOTARY TYPE O PRINT NAME OF NOTARY
NOTARY PUBLIC TITLE CLr-&&&I COMMISSION NUMBER
SLCCDV FORM NO.: 011-00