HomeMy WebLinkAboutFilled land AffidavitI q ' .I4
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ST. LUCIE COUNTY PUBLIC WORKS
BUILDING & ZONING DEPARTMENT
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
561-462-1553
FILLED LANDS AFFIDAVIT
I, the undersigned, am the owner of the following described property,
/226-333-o601 -00o%
(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.
oLc, lNe.
CHARLES M. CAMPBELL, sR .
Property Owner V 1 ee — P2 e 5 / D E nJ T Property Owner Date
(Print) (Signature)
STATE OF FLORIDA, COUNTY OF Z4 LU Q'1 F
SWORN TO AND SUBSCRIBED BEFORE ME THIS 1 - DAY OF 4 M) P_"E.L , 20a2,,
BYQ 1agAes 0 , d"hGoI WH S PERSONALLY K OWN TOME OR WHO HAS PRODUCED
AS IDENTIFICATION. II
L (seal)
SIGNATURE T NOTARY TYPE OR PRINT NAME OF NOT �M.'►TJ L. King
�'sCormntaaton * aQ 91US
NOTARY PUBLIC TITLE 0(n [9afiOMMISSION NUMBE}�.,goadedThm
Atl®nEia Boftdies Oo, ba.
SLCCDV FORM NO.: 011-00