HomeMy WebLinkAboutHolzmacher land fill affidavitPLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772)462-1553
FILLED LAND AFFIDAVIT
I, the undersigned, am the owner of the following described property,
21017 501 - 0064- 60d- $- Jfor4- Pierce Go lens op 2I-%5 -311 $LK !4-E
(Parcel Id#/Legal description/Address) R�
10725 1Iu+rys
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.
1 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.
PjW1 12, U �0
'perry er Name (Please Print)
eo a, w-v 1-Zoz0
Property Own
w r ignature Date
STATE OF FLORIDA, COUNTY OF M &r.-H A
ACKNOWLEDGED BEFORE ME THIS DAY OF n% . , 20 -AO
BY �Gp �q a
9VIZYwc4WHO IS PERSONALLY KNOWN TO ME (❑. ) OR WHO HAS
PRODUCED
i9riyerl, LrGcnsa. AS IDENTIFICATION.
lack
SIGNAWKE OF LQTARY
PUBLIC TYPE OR PRINT NOTARY
G& c(50'l05
COMMISSION NUMBER
(SEAL)
Notarye State of Florida
Ryan F. Stack
SLCPDSD Revised 04/112011
1 Nry Commission l28no24GG 950905
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