HomeMy WebLinkAboutFilled lands AffidavitST. 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,
133 0 - 3 31- 000 I — 000/1
(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, 1AI C.
CHARLES M. CAMP,BELLI -3R. iieW'Sr 1 I—
Property Owner V 1 e E — PRE S r DEti►T Property Owner Wte
(Print) �Q (Signature)
STATE OF FLORIDA, COUNTY OF�1�I C U 0A e—
SWORNN, TO AND SUBSCRIBED
� BEFORE ME THIS DAY OF 1 \1�1IFfn1 e-?- .2000.
BYO Y I�E S V, . l '�M.c_ "ej l WHOIEPERSONALLY NOWN TOME OR WHO HAS PRODUCED
AS IDENTIFICATION.
,I L. , (seal)
SIGNATURE Ct NOTARY 0TYPE OR PR NT NAM.E OF NO A Y 1� t.V 1
Nai ,, 1N,g■.' 1I.
('0mmlastonElp
a
NOTARY PUBLIC TITLE 5 COMMISSION NUMBERDan" 7bim
200
its Atlnetle BOZM6 on. b.
SLCCDV FORM NO.: 011-00