HomeMy WebLinkAboutFilled Land AffidavitPLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code regulations Di`rision
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772)462-1553
FILLED LAND AFFIDAVIT
RECEIVED
DFC 18 '0?9
1, the undersigned, am the owner of the following described prop rt,
Lucie County, Permitting
(Parcel IM/Legal description/Address)
for which I have applied to St. Lucie County for a final Development Permit. In
accepting this Final Development Permit, DP Number , 1 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 finrther 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.
Property Owner Name (Please Print)
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Property weer Signature Date
STATE OF FLORIDA, COUNTY OF J+' '— U C/ e—
ACKNOWLEDGED BEFORE ME THIS DAY OF "Ll 20 1q
BY 41.5 A M H L lot
WHO IS PERSONALLY KNOWis 70 ME EIrOR WHO HAS
PRODUCED
Sr6NI IRE OF NOTARY PUBLIC
COMMISSION NUMBER
SLCPDSD Revised 04/11/2011
AS IDENTIFICATION,
TYPE OR PRINT NOTARY
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RHONDA$ ROWE
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Commission # GG 104656
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Expires May 19,202
Bonded Thru Budget Notary Services
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