HomeMy WebLinkAboutFilled Lands AffidavitST. LUCIE COUNTY PUBLIC WORKS
BUILDING & ZONING DEPARTMENT
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-6652
561-462-1553
FILLED LANDS AFFIDAVIT
I, the undersigned, am the owner of the following described property,
12-25-331-0001-0Oo/8
(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.
OI.0 y INC.
CHARLES M. CAMPSELL13R. lI-IS-oo
Property Owner N/ I CC — PRES 1 6Eiv7 Property Owner to
(Print) (Signature)
STATE OF FLORIDA, COUNTY OF )T- . r LP°
SWORN TO, AND SUBSCRIBED BEFORE ME THIS �i� _DAY OF O L°Pl� � , 2�,
BYl 120ES 1 yUI.. OL�l_, bell W S PERSONAL OWN TO ME OR WHO HAS PRODUCED
AS IDENTIFICATION.
L. ~ (seal)
SIGNATURE T NOTARY TYPE OR PRI T NAME OF NOTAJY � eu,,,��• 114"y j.,
a Comnotselon i a
NOTARY PUBLIC TITLE C°C��I aSCOMMISSION NUMBER 'sl�.
SLCCDV FORM NO.: 011-00