HomeMy WebLinkAboutFilled Land Affidavit PLANNING&DEVELOPMENT SERVICES DEPARTMENT
BUILDING&CODE REGULATIONS DIVISION
2300 VIRGINLA AVENUE
FORT PIERCE,FL 34982-5652
(772)462-1553
FILLED LANDS AFFIDAVIT
I,the undersigned, am the owner of the following described property,
k® Cot -7 LLg(:�� lot t'a
(Parcel 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.
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Property Owner Name(Please Print)
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Pr erty Owner Signature Dat
STATE OF FLORIDA,COUNTY OF
ACKNOWLEDGED BEFORE MEE�T�HIS 2�_DAY OF T '✓ 20
BY 1"l l C-Y/,Yy d a)y eA— WHO IS PERSONALLY KNOWN TO ME OR WHO HAS
PRODUCED MUCV�I CaY1 1)" fJ6P(:;Q5 ` 'LY g t ,o AS IDENTIFICATION.
Gc � y t \0- C—'a
SIG URE OF NOTARY PUBLIC TYPE OR PRINT NOTARY
09 bCOMMISSION NUMBER
gW P4BG Notary Public State of Florida
;p Julie Baird (SEAL)
uA 0 Pa My Commission FF 163265
'4 OF F�.e Expires 09/25/2018
SLCPDSD Revised 08/24/2010